Background to this inspection
Updated
19 August 2023
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
The inspection was undertaken by 1 inspector.
Service and service type
This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service a short period notice of the inspection. This was because we needed to be sure the provider or manager would be in the office to support the inspection.
Inspection activity started on 9 March 2023 and ended on 14 March 2023. We visited the office location on 9 and 10 March 2023.
What we did before the inspection
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 information we currently hold about the service which includes statutory notifications. This is information the provider is required to send us. We contacted the local authority to gain feedback about the service. We used all this information to plan our inspection.
During the inspection
We spoke with 10 people and 1 relative about the service they were receiving. We spoke with 4 care workers by telephone. We visited the provider's office on 9 March 2023 and spoke with the interim care manager, regional manager and team leader. We reviewed records that included 9 people's care plans, risk assessments and medicine administration records. We also looked at records relating to the management of the service, including policies and procedures, quality assurance systems, staff recruitment and training records. We contacted 7 professionals to obtain feedback about working with the service.
Updated
19 August 2023
About the service
London Care (Lingfield Lodge) is a domiciliary care service situated in East Grinstead, West Sussex. They provide personal care for people living in extra care housing in a purpose-built block of flats that could accommodate up to 48 people. Extra care housing is designed for people who need some help to look after themselves, but not at the level provided by a residential care home. People living in extra care housing have their own accommodation and have care staff that are available when required either contracted or in an emergency.
The service supported people who were living with a range of complex needs including mental health, learning diability, physical disability and dementia. 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. There were 47 people being supported by London Care at the time of the inspection.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
Right Support:
People’s mental and physical health needs, and associated risks, were not always assessed appropriately so that staff could provide safe and responsive support. The service did not have enough appropriately skilled staff to meet some people’s needs and support them effectively. Feedback from people and professionals was that the skills and training of staff on supporting people with complex needs could be improved. Some people received support with their medicines although these were not always managed safely and effectively. There were sufficient staff to support people although feedback from people on the timings and lengths of calls were mixed.
Right Care:
People did not always receive personalised care. Some care plans lacked detail about people’s physical and mental conditions and what staff should do to support these responsively. Staff understood how to apply the principles of safeguarding people, and how to recognise and report abuse. There was a lack of personalised approach to identifying individual risks associated with people’s mental and physical health conditions. The provider's quality assurance systems had not identified these shortfalls. Some people received support with their medicines although these were not always managed safely and effectively.
Right Culture:
People told us that management support and approach was inconsistent and that interim management arrangements had not been as effective or consistent in their oversight of staff or their support. Quality assurance systems were not fully effective as they had not identified shortfalls identified in the full report. People’s communication needs had been assessed and information could be provided to people in an accessible format. Complaints were dealt with in line with the provider's policy.
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 16 December 2021 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
We have identified breaches in relation to safe care and treatment, staffing, person centred care and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.