Laurel Homecare Ltd

Laurel Homecare Ltd provides personal care to people living in their own homes. Not everyone supported by 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 the time of the inspection the service was providing personal care to 35 people, two of whom were in hospital.

The provider also runs a day centre. This provision is not regulated by CQC.

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

People told us they felt safe with staff. Relatives were confident their loved ones were safe. Staff had received safeguarding training and there were robust systems in place to manage safeguarding concerns.

Staff understood the risks people faced and supported them in ways that reduced these risks. New risks were identified and plans put in place to reduce their impact.

There were enough safely recruited and trained staff to meet people’s needs. The registered manager monitored staffing capacity to ensure this was the case.

People received their medicines safely and systems were in place to ensure medicines administration was monitored and staff competency was ensured.

Staff were confident in their understanding of infection control measures. People told us staff wore PPE appropriately.

There were systems in place to ensure any restriction of people’s liberty was identified and managed appropriately.

Improvements had continued to be embedded in the oversight of the service. There was an open culture within the staff team which meant staff felt valued and able to focus on the people they supported. People and staff were complimentary about the management team. Audits and checks were completed to monitor the quality and safety of the service.

There were robust processes in place to drive improvement and to continually develop the service in line with the needs of the people and the staff team.

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 (supplementary report published 26 September 2022) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Laurel Homecare Ltd provides personal care to people living in their own homes. Not everyone supported by 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 the time of the inspection the service was providing personal care to 31 people.

The provider also runs a day centre. This provision is not regulated by CQC.

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

People told us they felt safe with staff, and staff had received safeguarding training. However, two safeguarding concerns had not been responded to appropriately by staff and the registered manager.

Staff understood the risks people faced and supported them in ways that reduced these risks. There were enough staff, who had been safely recruited and received appropriate training, to meet people’s needs.

People received their medicines safely and systems were in place to ensure medicines administration was monitored.

We received positive feedback from people about the provider's infection prevention and control processes. People told us staff always wore PPE appropriately.

People's needs were assessed before the service began to provide care and support. People’s views were sought and this ensured their preferences informed their care plan. People were supported to access appropriate healthcare.

People were supported to have maximum choice and control of their life 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.

Improvements had been made in the oversight of the service. There was an open culture within the staff team that maintained a focus on the people they supported. People were complimentary about the management. Audits and checks were completed to monitor the quality and safety of the service.

There were clear processes in place to drive improvement and to continually develop the service in line with the needs of the people and the staff team.

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 requires improvement (published August 2021).

Why we inspected

We had received feedback from stakeholders that the service had improved since our last inspection. The inspection was also prompted in part due to concerns received about safeguarding. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified a breach in relation to how people are safeguarded from abuse. We have taken enforcement action requiring the provider to address this.

Follow up

We will meet with the provider following this report being published 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.

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.

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

At our last focused inspection, the providers procedures for assessing the risks to people's health and safety were not sufficiently robust. At this inspection improvements were still required.

The registered manager did not always have sufficient oversight of the service through their system of checks and audits. These systems were not robust enough because they had not identified and resolved the concerns we found. Systems had either not been set up correctly or staff needed more training to operate them effectively.

Risks to people had not always been kept under review. Written guidance for staff on the management of risks to people were not clear or up to date. People's medicines were not always safely managed.

We have made a recommendation about the management of some medicines.

The provider followed safe recruitment processes to help ensure staff had appropriate background checks before starting employment. Staff received a suitable induction with ongoing training and support on how to meet people's needs.

People were supported to maintain their health and staff understood people's healthcare needs. People received food and drink of their choice.

People told us staff were kind, friendly and caring, however they told us that they did not know what or when care workers would be arriving to support them.

Staff received training in safeguarding people. They knew that they needed to report any suspected abuse and/or discrimination.

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 requires improvement (published 01 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider has taken action to mitigate the risks, but more time is needed to embed the improvements.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. Please see the safe and well led key sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Laurel Homecare Ltd on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Laurel Homecare Ltd is a domiciliary care provider. It provides care and support to people living in their own homes. At the time of the inspection they were providing a personal care service to 42 people.

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. Where they do, we also consider any wider social care provided.

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

People, their relatives, staff and community professionals spoke positively about their working relationships with the provider. They found the provider open, approachable and supportive. Staff were enthusiastic in their work and felt valued by the provider. Any lessons learnt were used as opportunity to improve the quality of the service.

People and relatives gave us positive feedback about the service and said they received a service they could rely on. However, we identified areas needing improvement in safety and quality monitoring.

The service did not have effective systems in place to monitor quality and safety. Risks to people had not always been kept under review. Written guidance for staff on the management of risks to people were not clear or up to date. People’s medicines were not always safely managed.

An out of hours service was provided to give staff and people who used the service guidance and support when the office was closed. However, there was no formal monitoring of follow up calls or data to analysis any trends or mitigation of risk.

Staffing levels were sufficient to allow staff to support people safely, people were supported by a small team of staff they knew well and trusted.

Assessments were carried out prior to people joining the service to ensure their needs could be met. People were supported to maintain good health and access to a range of healthcare services where needed.

Staff understood how to recognise and report potential abuse involving people who used the service. Steps had been taken to protect people, staff and others from the risk of infections. Staff knew how to report accidents and incidents.

We identified a breach of regulation regarding the effectiveness of the services quality assurance processes.

Rating at last inspection

This service was registered with us on 06 September 2019 and this is the first inspection.

Why we inspected

This was a focused risk based inspection.

We have identified a breach in relation to effective governance of the service.

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 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