Background to this inspection
Updated
26 August 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
This inspection was carried out by one inspector and an Expert by Experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency, which provides personal care and support living in their own homes within the community. The service specialised in providing care to meet the needs of people who had experienced personal injuries, including acquired brain and spinal cord injuries.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post, who was also the nominated individual and the clinical director. The nominated individual is responsible for supervising the management of the service on behalf of the provider. The provider had appointed a Head of Operations, who had begun the application process to become the registered manager.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 30 June 2022 and ended on 1 August 2022. We visited the location’s office on 1 July 2022.
What we did before the inspection
We used information gathered as part of monitoring activity that took place on 8 March 2022 to help plan the inspection and inform our judgements. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed this key information during the inspection. We sought feedback from the local authority, safeguarding team, case managers and other professionals who work with the service. We checked information held by the Companies House and the Information Commissioner’s Office. We checked for any online reviews, relevant social media and looked at the content of the provider’s website. We also reviewed the provider’s social media sites to confirm they had published our last inspection ratings. We reviewed notifications from the service. The law requires providers to send us notifications about certain events that happen during the running of a service. We used all of this information to plan our inspection and took this into account when we inspected the service and made the judgements in this report.
During the inspection
We endeavoured to contact 22 people who use the service or their representatives and spoke with two people and nine relatives about their experience of the care provided to their family member. Between 30 June and 22 July 2022, we spoke with 25 case managers/clinical leads who had been legally appointed to commission people's care. In this context, case managers are health and social care professionals with expertise in the areas of support required by people, for example, spinal cord and acquired brain injuries. We spoke with the registered manager, the head of operations, the main director, the managing director, the clinical nurse manager, three regional clinical nurse leads, a nurse, two senior care coordinators, four care coordinat
Updated
26 August 2022
About the service
Libertatem Healthcare Group Ltd provides personal care and support to people living in their own homes, who have experienced a personal injury, for example traumatic, acquired brain and spinal cord injuries. People's care was commissioned by legally appointed case managers. At the time of the inspection there were 63 people receiving personal care from 237 staff.
People’s experience of using this service
People experienced high quality care, which consistently achieved outstanding outcomes, significantly improving the quality of people’s lives. Professionals reported that the provider’s recruitment process, directly involving the person in the selection process of their dedicated care team was exceptional and led to them experiencing quality of care to the gold standard. The management team had an extremely effective support and appraisal system, which recognised that continual development of staff skills and knowledge was integral to the provision of the highest quality care. Staff were highly valued in their roles and the provider proactively supported them in their professional career development. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff worked effectively with healthcare professionals to make sure care and treatment met people’s changing needs.
The service provided person-centred care and support, which achieved life changing results for people rehabilitating after traumatic injuries, particularly supporting them to be discharged and cared for at home, when multi-disciplinary team professionals doubted it was possible. People were enabled to access the community and take part in stimulating activities, which enriched the quality of their lives. The provider went the extra mile to support people’s communication needs, for example, by recruiting a dedicated support team who could speak to a person in their own language to understand their needs and concerns. Staff had developed exceptional skills at supporting people and family members to reconnect after enforced separations caused by traumatic events. The registered manager thoroughly investigated complaints and shared lessons learned with staff to improve the service. When people had died, they experienced a comfortable, dignified and pain free death, in a manner which respected their wishes.
People experienced safe care and were protected from avoidable harm by trusted staff, who had completed safeguarding training and knew how to recognise and report abuse. Staff identified and assessed risks to people effectively and managed them safely. The registered manager ensured enough staff were deployed, with the right mix of skills to deliver care and support to meet people’s needs. People received their medicines safely from staff, in accordance with recognised guidance.
People experienced caring relationships where staff treated them with kindness and compassion in their day-to-day care. People were supported to make decisions about their care and these choices were consistently respected by staff. Staff treated people in a respectful manner and intervened discretely to maintain their personal dignity when required. Staff knew how to comfort and reassure people when they were worried or confused.
The management team led by example and promoted a strong caring, person-centred culture where people and staff felt valued. Staff were passionate about their roles and consistently placed people at the heart of the service, clearly demonstrating the caring values of the provider. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent further occurrences. The governance structure ensured there were robust measures to monitor quality, safety and the experience of people within the service. Quality assurance was embedded within the culture and running of the service, to drive continuous improvement.
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.
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 (report published 29 March 2019)
Why we inspected:
This was a planned comprehensive inspection, in line with our inspection programme.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.