Libertas Care Limited - 3 The Barley Yard

Libertas Care – 3 The Barley Yard is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection 49 people were receiving the regulated activity of personal care. Care packages ranged from a few hours a week to live-in-care.

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

People were supported by an agency which was well managed and provided a very personalised service to people. The provider was committed to seeking people’s views and ensuring on-going improvements to the care people received. People told us staff were always happy and cheerful when they visited them.

People received their care safely from staff who had been well recruited and trained. This helped to minimise the risks of abuse to people. Everyone we spoke with was very happy with the service and said they would recommend it to others who needed support in their home.

People could be confident they would receive their support at the time requested and it would be provided by staff they knew well and felt comfortable with.

People benefited from an on-call system which meant they could speak to a member of the management team any time of the day or night. This meant there was always someone to share concerns with or ask advice from.

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.

People were cared for by staff who were kind and caring and often went out of their way to help them. People felt valued and respected by staff and the provider. People were fully involved in planning their care and continued to be in control of how and when care was provided.

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

Rating at last inspection

Requires Improvement (Report published 24 October 2018) and there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

We gave the provider 48 hours' notice because the location provides a domiciliary care service and we needed to be sure the registered persons would be available for the inspection. It also allowed us to arrange to speak with people receiving the service.

Libertas Care Limited provides personal care to people living in the area of, Crewkerne, Yeovil and the surrounding villages. At the time of this inspection they were providing personal care for 51 people. They also provided a domestic service to people living in their own homes.

The service was run by a company who was the registered provider. There was a registered persons’ who is a person that 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. In this report when we speak about both the company and the registered persons’, we refer to them as being, 'the registered persons'

At the last inspection we rated the service good. At this inspection we found the evidence did not continue to support the rating of good and there was evidence that showed serious risks or concerns. We have therefore changed the rating to requires improvement.

This is because, whilst people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; On the day of the inspection the policies and systems in the service did not fully support this practice. For example, care records showed that people had not signed consent forms to receive care and support and capacity assessments had not been carried out to ensure people were offered care and support in line with national guidance. We have made a recommendation to ensure capacity assessments for people are line with current national guidance and legislation.

The registered persons had a commitment to improving the care and support people received. However, current governance arrangements had not consistently identified shortfalls within the service. For example, people’s medicines were not managed safely or administered appropriately to make sure people were safe.

Staff had received training on how to recognise the various forms of abuse, which was regularly updated. The service carried out risk assessments to identify any risks to the person using the service and to the staff supporting them.

There were enough numbers of staff available to keep people safe. The provider's recruitment processes minimised the risk of unsuitable staff being employed.

Staff were aware of the reporting process for any accidents or incidents. Where incidents had occurred, the provider had used these to make improvements and any lessons learned had been shared with staff.

The provider had systems in place to assess people’s needs and choices. Staff had the right skills, knowledge and experience to deliver effective care and support because they received training which enabled them to carry out their roles effectively.

Staff worked successfully with healthcare services to ensure people’s health care needs were met and respected people’s privacy making sure care was provided in a dignified and respectful way.

The support plans were detailed, set out clearly and easy to read. Reviews reflected on their achievements, goals, and aspirations and where changes were identified these were reflected in the person's care plan.

There was a system in place to manage and investigate any complaints. Where concerns or complaints highlighted shortfalls in the service action was taken to make future improvements.

We found one breach 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.

Further information is in the detailed findings below.

Libertas Care Limited - 3 The Barley Yard provides personal care to people living in the area of Chard, Crewkerne, Yeovil and surrounding villages. At the time of this inspection they were providing personal care for 35 people. They also provided a domestic service to people living in their own homes.

The last inspection of the agency was carried out on 09 October 2013. No concerns were identified with the care being provided to people at that inspection.

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.

People who received care and support from Libertas Care Limited said they were very happy with the service provided. Everybody said the staff went above and beyond what was expected of them. People were supported by caring and compassionate staff who went that “extra mile” to ensure people were able to live as independently as possible in their own homes. This meant people were able to continue to enjoy social interests as well as receive personal care. For example one person living with dementia was supported to attend a family wedding whilst another person was supported to go for walks or visit the shops. Arrangements were being made for one person who did not have family living in this country to spend Christmas Day with a care worker and their family. A relative said, “They [staff] are all very caring and go that extra mile for [the person] he is so happy when they are around.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Care workers were allocated to people who had similar interests so the person could build a relationship with them if they wished. People told us staff knew them and how they liked to be looked after. People were supported by a consistent staff team. One person said, “I know all the girls who visit me and when they take on someone new they introduce them and make sure I know them.”

The agency operated an out of hour’s service when an on call manager would be available by phone. The registered manager found this service was very beneficial to some of the people living with dementia. One person living alone would call the number regularly during the night for a chat and reassurance. This meant the service enabled that person to continue to live independently in their own home with the reassurance that someone was there to support them.

A full assessment of people’s needs and expectations was carried out before a care package was agreed. The registered manager confirmed they would only take new people on if they could meet their needs and had the staff available to provide consistent support. If they were unable to meet their needs they would signpost them to another agency or health care professionals.

People told us they thought staff had been trained appropriately to meet their needs. Care workers had access to training specific to their roles and the needs of people. For example the agency specialised in providing support for people with complex needs such as living with dementia, motor neurone disease (MND) or mental health problems. Staff received training specific to those needs such as from the MND Society. Care workers understood people’s needs and were able to explain to us how they would care for each person they visited. A healthcare professional said, “Without exception the staff I have encountered have been professional, knowledgeable and above all caring.”

Care plans included clear guidance for staff, to enable them to deliver consistent care the way people preferred. Care plans had been reviewed regularly with people and changes made when needs had changed. People confirmed they discussed their care plans with staff and had signed to show they agreed with them. People said staff always sought their consent before providing care and support. One person said, “They are always very polite and respectful and ask me before they do anything.” One relative said, “They [staff] know how to communicate with [the person] so they can still obtain consent from him so he feels in control.”

People were protected from abuse because the provider had systems in place to ensure checks of new staffs characters and suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse. People said they felt safe when being cared for; we observed people were happy and relaxed with staff during our home visits.

People who needed support to access health care professionals were given assistance to do so such as visiting the GP surgery or attending hospital appointments. Care plans included an emergency information sheet which gave important information for ambulance crews or hospital staff in an emergency. This meant vital information would not be overlooked in an emergency situation. Staff monitored people’s health with their consent and could direct to healthcare professionals as appropriate.

The agency had a complaints policy and procedure that was included in people’s care plans in large print. People said they were aware of the procedure and had numbers they could ring. People and staff spoken with said they felt confident they could raise concerns with the manager and senior staff.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

One relative said 'the service provided meets the needs; the needs are constantly changing and Libertas are on top of that'. Two people said they felt staff knew their individual preferences and that staff met their needs 'very well'. Everyone said that staff treated them with dignity and respect.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The four staff we spoke with knew the individual care and support needs of people who used the service. They also showed us they knew people's preferences about how their needs were to be met.

People told us that they had a good relationship with staff and they "felt safe at home as they knew the carers where going to come in at the same time every day". This person was very clear that without the carers coming in when they wanted they to he would not be able to go out on their daily walk to collect the recycling around their home.

Two people told us that they appreciated the Care Managers visits to see how they were getting on. They liked the fact that the Care Manager shadowed staff to see that they were carrying out the care and support appropriately and were involving the person at all times.

We were told by one person that "the wonderful carers made sure I could reach everything I needed as I was at risk of falling due to an already broken ankle and without their support I would have been in hospital instead"

We observed a person centered approach to the planning and delivery of care and support and a family member said, "nothing is too much trouble, we could not have asked for anything they always have time for both mother and myself".