Lalis Direct Care Ltd

At our last inspection carried out on 6 and 18 October 2017 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These were for not acting on complaints and for good governance. At this inspection we found that these had been addressed by the provider.

Following the last inspection, we asked the provider to complete an action plan to show what they would do improve the key questions of responsive and well-led to at least good.

During this inspection we found that the provider had improved their systems to enable people and relatives to make complaints and had responded appropriately in addressing their concerns to their satisfaction. During our previous inspection we had found that care calls monitoring was not effective in identifying missed and late calls and some people had complained about this when we spoke with them. During this inspection we found that the provider now had an electronic call monitoring system linked to the local authority, that flagged missed and late calls. This was monitored by the office staff who ensured care calls took place as scheduled. In addition, the provider had employed a compliance manager to check the quality of the service provided and to introduce improved systems and paperwork.

This service is a domiciliary care agency and provides personal care to people living in their own houses and flats in the community. It provides a service to older adults some of whom are living with dementia, and younger disabled adults.

Not everyone using Lalis Direct Care Ltd receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection 32 people were receiving the regulated service of personal care.

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.

We found that people and relatives spoke positively about the care they received. They described staff as caring, kind, respectful and polite. They told us staff gave them a choice about their care and support and communicated well with them. They were happy with the service provided and several people stated they would recommend the provider to other people.

People signed their care plans to show they had given consent to the care and treatment stated. The provider had arrangements to ensure that the principles of the Mental Capacity Act 2005 were followed, but on a few occasions mental capacity assessments were not being carried out according to these principles. The provider addressed these when we pointed this out.

People and relatives confirmed care was provided as they wanted it to be done and that their care packages were reviewed with them on a regular basis by the office staff. People had care plans that were person centred and care provision was personalised. We found that some people’s care records did not always contain comprehensive information about their background or diverse needs We brought this to the director’s attention who told us they were updating people’s care plans as they reviewed them. Staff had received diversity training and could tell us how they supported people to meet their diverse needs.

The provider undertook assessments to identify risks to people and put in place guidance for staff to mitigate the identified risks. When people had health conditions such as diabetes there was also guidance for staff so they could take appropriate action where necessary. We found staff had contacted people’s GP, district nurses or emergency services appropriately when they found people were unwell or had fallen.

Staff received an induction and training to support them in their role. They told us the registered manager was supportive and approachable as were the office management team.

Staff who administered medicines received training and all medicines records reviewed were completed appropriately. People’s records contained information about their medicines and possible side effects for staff reference.

Staff had received safeguarding adult and child protection training and told us how they would recognise signs of abuse and report concerns appropriately.

The registered manager, director and compliance manager tracked, safeguarding concerns and incidents and accidents and reviewed people’s records, daily notes and medicines administration records to monitor and improve the quality of the service provided.

The provider worked with commissioning bodies to improve the quality of service provided and to ensure its future sustainability.

There is 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. At the time of our inspection the registered manager was on leave as such we spoke with one of the company directors throughout our inspection.

At our last inspection in March 2017, we found eight breaches of the regulations. We imposed requirement notices on the provider to address the breaches of regulations in relation to person centred care, receiving and acting on complaints, the need for consent, service users from abuse and improper treatment, safe care and treatment, good governance, notification of other incidents and failure to display performance indicators.

After the inspection in March 2017 the provider sent us action plans to say what they would do to meet the legal requirements in relation to the breaches of regulation. They told us they would complete the actions to meet the legal requirements by 30 September 2017.

During this inspection, we found a number of improvements had been made by the provider but there were still some concerns that required improvement.

At our last inspection, some people told us of late and missed calls. During this inspection, the majority of the people we spoke with said the service had improved. However, some people and relatives still told us staff were late at times and there had been missed calls.

Previously people did not feel empowered to raise complaints. During this inspection, we found people had been empowered to complain. However some relatives felt when they did raise concerns whilst they were listened to sympathetically the matter was not addressed to their satisfaction. The complaints raised were about late and missed calls.

The provider and registered manager undertook regular checks and audits to assess the quality of the service provided. However, our findings during this inspection showed that whilst there has been an improvement in the provider's governance arrangements, these were not always effective because of the areas for improvements that we found during the inspection that the provider had not identified and addressed.

The provider has systems in place to recruit staff in a safe manner.

At our last inspection, safeguarding adult concerns were not always referred to the appropriate authority and the registered manager did not have an overview of the safeguarding adult concerns. During this inspection, we found that safeguarding adult concerns had been referred appropriately and the registered manager had an overview of concerns.

The provider had appropriate risk assessments in place to help keep people and staff safe from harm. They also ensured the staff had adequate supplies of protective equipment to manage the risk of cross infection.

Previously medicines were not administered in a safe manner. We found the provider had taken steps to ensure staff administered medicines in an appropriate manner.

At our last inspection, we found that the service was not working to the requirements of the Mental Capacity Act 2005 (MCA). At this inspection, we found people were asked their consent both in writing and verbally. The provider had taken steps to ensure staff understood their responsibilities to uphold people’s legal rights.

During our previous inspection, we found that the provider did not consider in people’s care plans their nutrition and hydration support needs. During this inspection, we found this had been addressed, there was now clear guidance for staff to follow, and there were daily recordings of food and drink intake to allow monitoring to take place.

At our last inspection care plans were not person centred. The provider had ensured people now had person centred plans that told staff how they wished to be supported and their preferred method of communication. Care plans were reviewed and updated on a regular basis with people’s involvement.

Previously we had found the provider was not informing us of all notifiable incidents. A notification is information about important events, which the provider is required to send us by law. We found that the provider was now keeping us informed of notifiable incidents and events which occurred at the service.

Previously we had found that the provider had failed to display the CQC performance indicators for the service. The provider had addressed this and performance indicators were available in the office and on their website.

Staff described the management team as supportive and staff were provided with training and received supervision to support them to undertake their role.

The provider and staff supported people to access the appropriate health care in a timely manner.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to receiving and acting on complaints and good governance. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Lalis Direct Care Limited is a domiciliary care agency that provides personal care for people in their own homes. At the time of our inspection, the agency provided approximately 900 hours of support on a weekly basis to 81 people. These included people with learning and physical disabilities, sensory impairments, older people and people who lived with dementia.

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.

The registered manager was supported by the provider, the branch manager, two senior care coordinators, two payroll officers and 22 care workers.

The service was last inspected on 03 February 2016. At that time, we found the agency was not meeting all the required Regulations. We observed that people were not always safe as the agency did not have detailed plans in place for management of identified risks to people’s health and wellbeing. Additionally, the agency’s quality audits were not effective in highlighting concerns and mitigating risks to people.

At the inspection on 20 March 2017, we found some improvements had been made and further improvements were needed in other areas.

The agency did not always ensure that people were safe from harm and abuse. People and their relatives gave us mixed feedback about care they received from care workers who supported them.

Care workers received safeguarding training, however, not all of them had a good understanding of the principles of safeguarding vulnerable adults.

The agency did not always manage medicines administration safely and there was a risk that people would not receive their medicines as prescribed.

The agency did not always work within the principles of the Mental Capacity Act 2005 (MCA) and there was a risk that decisions related to people’s everyday care were not made in their best interest or with their consent.

The agency did not always involve people in planning of their care and did not always take into consideration people’s personal wishes and preferences.

People told us they were not always satisfied with how the agency dealt with their complaints.

The agency had systems in place to asses and monitor the quality of the service however they were not always effective.

The agency did not follow their legal duty to submit statutory notifications and did not display their most recent performance rating on their website as required by the Regulations.

Care workers had guidelines on how to manage risk to people’s health and wellbeing, however, some care documents had inconsistent information on what these risks were.

The agency had a process in place for reporting of incidents and accidents and care workers followed it.

The agency had robust recruitment procedures in place to ensure only suitable care workers were appointed to work with people who used the service.

The agency had a rota system in place to ensure that all calls were covered and care workers knew who they were assigned to visit that week.

The agency worked closely with the local authority and other health care professionals to make sure people were supported to maintain good health and have access to healthcare services.

New care workers undertook an induction that consisted of the training the provider considered mandatory and shadowing of more experienced colleagues.

Care workers received regular training, supervision and appraisal of their work.

People’s care plans consisted of clear and practical instructions on how to support people they cared for.

People we spoke with told us care workers respected their dignity and privacy when providing personal care.

The agency sought regular feedback from people and their relatives about the service provided.

Care workers told us they felt supported by the registered manager and the office staff and that there was a fair and open culture of communication within the agency.

External stakeholders had mixed feedback about their experience of the quality of the service provided by the agency.

We have made two recommendations relating to the review of risk assessment documents and gathering information about nutritional needs of people who used the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Lalis Direct Care Limited is a domiciliary care agency which provides personal care for people in their own homes. At the time of our inspection, there were 81 people using the service, all of which were funded by their local authority. People who received a service included those with physical frailty or memory loss due to the progression of age. The frequency of visits varied from one to four visits per day depending on people’s individual needs.

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.

The risks to people’s wellbeing and safety had been assessed, however there were no detailed plans in place for some of the risks identified. There were procedures for safeguarding adults and the care workers were aware of these. Care workers knew how to respond to any medical emergencies or significant changes in a person’s wellbeing.

Feedback from people and their relatives was mostly positive, although some people said that care workers were sometimes late and did not always inform them of this. Some people said they had different care workers visiting which made it difficult for them to build a rapport and get to know them. However, all of them said the care workers were very good and that they trusted them. Comments from people included, “They are lovely”, “my carer is very competent”, “sometimes they are late, but they always let me know”, “it’s perfect, I would not wish for better”, and “10 out of 10.”

People’s needs were assessed by the local authority prior to receiving a service and support plans were developed from the assessment. Most people told us that they had not received a visit from the registered manager or the care coordinator, and had not taken part in the planning of their care. One person, however, told us that they had been involved in the planning of their care. Everybody using the service said that they were happy with the level of care they were receiving from the service.

The registered manager was aware of their responsibilities in line with the requirements of the Mental Capacity Act (MCA) 2005 and the deprivation of liberty (DoL), but told us that none of the staff had received in depth training in this. Records showed that people had consented to their care and support and had their capacity assessed prior to receiving a service from Lalis Direct Care Limited.

There were systems in place to ensure that people received their medicines safely and all staff had received training in the administration of medicines.

The service employed enough staff to meet people’s needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People’s health and nutritional needs had been assessed, recorded and were being monitored. These informed carers about how to support the person safely and in a dignified way.

Carers received an induction and shadowing period before delivering care and support to people. They received the training and support they needed to care for people.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

There were systems in place to monitor and assess the quality and effectiveness of the service, but audits had failed to highlight that there were no detailed plans in place for some risks identified during people’s assessment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the safe care and treatment of people and quality assurance. You can see what action we told the provider to take at the back of the full version of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on discussions with management during the inspection, speaking with people using the service, their relatives, 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?

People were treated with dignity and respect by the staff. People we spoke with told us their care workers always protected their privacy when offering personal care.

Systems were in place to make sure that accidents and incidents were reported along with complaints and other concerns and action taken when required. This reduced risks to people and helped the service to continually improve its performance.

The provider had proper procedures to manage and record the administration of medicines along with reporting arrangements for adverse events and missed medication. Staff had the necessary training to administer medication in line with these procedures.

There were procedures for managing emergencies and staff were aware of relevant contact details to access help and support.

Recruitment practice was safe and thorough and ensured that suitable checks were in place with regard to qualifications, employment history, identity and criminal records. There was suitable induction training for new staff and on-going supervision checks to ensure that staff carried out their duties safely.

Is the service effective?

People using the service experienced care that was planned and delivered to meet their needs and mitigate any risks. People using the service and their relatives were involved in the development of their care plans.

Care needs were reviewed on a regular basis and care plans could be modified if needs changed. Records showed that the care delivered reflected the current care plan.

People we spoke with told us that their care workers were punctual and carried out their duties effectively. A relative of one person said, 'They're very good, very kind and always on time.'

The provider recruited staff that were suitably skilled and qualified to fulfil their roles.

Is the service caring?

People we spoke with were satisfied with the care and support they experienced. Staff we spoke with were aware of the importance of communicating clearly and offering people choices in how their care was delivered.

People we spoke with told us their care workers were kind and helpful and always willing to meet their needs.

One person remarked, 'They're always very willing and open to suggestions and will do extra things if I ask.' Another commented, 'They're very nice, kind people. Nothing is too much trouble. I cannot praise the people that come here highly enough.'

A family member of one person said, "They're all lovely people ' there's nothing negative at all."

Is the service responsive?

People using the service received a quarterly satisfaction survey in which they were asked to rate the quality of the service they received. Results to date indicated a high level of satisfaction with the service.

Monthly reports were produced by management for each person so that any concerns could be addressed promptly and changes made to care arrangements if necessary.

The provider made regular telephone calls to people using the service during which people were encouraged to express their views.

There was a written complaints procedure which was readily available for people using the service. People were aware of the written procedure.

Two complaints had been recorded and had been investigated and managed correctly.

Is the service well-led?

The provider had a variety of systems to monitor the quality of service provided and audit their performance.

People using the service and their relatives were provided with information about the service and were contacted regularly to obtain their feedback and views.

There were appropriate procedures for dealing with complaints and reporting accidents and incidents.

Staff had regular meetings at which they could discuss their case load and any issues or concerns. Managers conducted regular checks at the homes of people using the service while care workers were there to ensure the care delivered was of good quality and in line with needs.