Archived: Litch Care Services Limited Liverpool

Litch Care Services Limited Liverpool is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection there were 2 people being supported by the service. Not everyone who uses the service receives 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

People were exposed to avoidable risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Records for the administration of medication were not always completed and we were not assured all relevant information was included on medication administration records (MAR) to enable staff to safely administer medicines.

Service users were at risk of receiving unsafe care and treatment as care plans and risk assessments were not adequate or up to date. Medical and health needs were not properly described, or risk assessed; information about service user needs and care was contradictory placing people at risk of inappropriate or unsafe care.

Assessments of people's individual needs had not been consistently recorded and did not consider best outcomes for people. Care plans were not person centred and did not hold sufficient information to guide staff when supporting people. The provider had not fully explored how to present information in an accessible way to meet individual needs.

Robust recruitment practices were not followed. Systems to support and develop staff did not ensure they had the knowledge and skills needed to support people safely and effectively. Conflicting information was provided by management for permanent staff employed at the service and records demonstrated inaccuracies.

Feedback from a family member was positive about the support provided and felt the

registered manager was responsive. We were told staff enabled people to make their own decisions and offered choice when carrying out tasks. Management, however, did not demonstrate a clear understanding of the Mental Capacity Act 2005 and the service was not working within the principles of the Mental Capacity Act. (MCA). Records did not clearly evidence capacity had been assessed and decisions were made in the people's best interests.

Governance systems were ineffective. The provider had failed to implement systems to assess, monitor and improve the service. Audits and checks completed by the registered manager had not identified the issues we found during this inspection. The registered manager failed to demonstrate knowledge and understanding of their role, quality performance, risk and regulatory requirement.

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 Inadequate (published 12 October 2022). At this inspection we found the provider remained in breach of regulations regarding the management of medicines, risk management and the governance of the service.

Why we inspected

We carried out an announced inspection on 16 and 20 November 2023 following on from breaches that were found at the previous inspection in October 2022. The provider completed an action plan after the last inspection to show what they would do and by when to make improvements.

We undertook this focused inspection to check improvements had been made and if the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained as inadequate. This is based on the findings at this inspection.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, fit and proper persons employed and governance at this inspection.

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

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 time frame 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.

Litch Care Services Limited Liverpool provides personal care to people living in their own homes within the Knowsley area.

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 the time of our inspection, the service was supporting 6 people with their personal care needs.

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

Assessments of people’s identified risks had either not been completed or contained inaccurate information resulting in risk scores being incorrect. Staff did not always have access to information or guidance about how to manage people’s identified risks. This was because care plans were either not available or did not contain enough information. This placed people at risk of avoidable harm.

Staff we spoke with failed to demonstrate a thorough knowledge of people’s identified risks and needs. One staff member told us they did not always have time to read people’s care plans.

The registered manager failed to demonstrate adequate knowledge and understanding of their role and responsibility regarding the assessment of people’s capacity. Some people’s care plans contained information that contradicted the outcome of mental capacity assessments.

People were not supported to have maximum choice and control of their lives and staff did not 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.

Staff had not received the right training and support to carry out their role. Whilst staff had received up-to-date training in relation to medicine administration and manual handling, all other training was out of date. Staff supervisions had not been completed since 2021.

People’s needs had not always been assessed in line with best practice guidance. Assessments had either not been completed or lacked accurate and detailed information for staff to follow in order to provide safe and effective support.

Governance systems failed to drive the necessary improvements to the quality and safety of the service. Audits and checks completed by the registered manager had not identified the issues we found during this inspection. The registered manager failed to demonstrate knowledge and understanding of their role, quality performance, risk and regulatory requirements.

The issues identified in relation to the assessment of people’s risks and needs meant we could not be assured certain people were receiving care that was person-centred and based on their individual needs and preferences. We have made a recommendation regarding this.

Safeguarding incidents were documented, and records showed that some action had been taken to address concerns. However external professionals told us the registered manager’s response to concerns was not always appropriate and failed to offer assurances they had learned from incidents.

We received mixed feedback from family members regarding staff interactions and the overall quality of the service their relative received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14 December 2020 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 breaches in relation to risk assessing, staff training and support, the application of the Mental Capacity Act 2005, care records and governance at this inspection.

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 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. 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.