Lilyrose Care Group Ltd - Cheshire/Derbyshire

Lilyrose Care Group is a domiciliary care agency which supports people in their own homes. At the time of our inspection 14 people were in receipt of the regulated activity ‘personal care’.

People’s experience of using this service:

We found three breaches of regulation at this inspection in relation to recruitment, consent to care and governance.

People and their relatives raised issues about some inconsistencies between office staff and care staff, however they felt the service they received from care staff was good. People told us that staff were kind and friendly and knew them well.

We have made a recommendation about medication records. Care records were not always updated to reflect changes made to people’s medication. There was no written guidance for staff about the administration of medication prescribed to people to be taken when required.

Recruitment was not consistently managed safely. The necessary checks were not completed prior to staff starting work. The provider had found some of these issues prior to our inspection and had taken corrective action to address this.

The registered provider was not acting within the principles of the Mental Capacity Act 2005. Where necessary, the provider had not recorded that people’s capacity was assessed, or that decisions were taken and recorded in people’s best interests looking at the least restrictive options.

Care plans contained some detail and information to assist staff in meeting people’s needs. However, these had not been regularly updated and the information contained at the office did not always match the care plans in people’s homes. Records in general were disorganised. Care records had not always been updated to reflect changes in people’s needs. Staff were aware of the changes via weekly email updates and care was provided by the same group of carers, so the impact on people was reduced. The provider had identified this issue prior to our inspection and was taking steps to improve records.

There was no manager in place at the time of our inspection. The systems in place to monitor the quality and safety of the service and make improvements were not always effective. They failed to identify issues we found in this inspection. The provider did not maintain a record of checks they carried out on the service. There was no evidence to show that the provider had oversight of the service as there were no quality assurance systems in place for the provider to monitor and improve the service. The systems in place at the service had not been followed recently and this had led to documentation being out of date or procedures not being followed by staff. Some documentation could not be located that was requested. Following the inspection, the provider confirmed management arrangements and sent an action plan of how and when they intend to make the required improvements.

Staff received an induction when they started work and received ongoing training. Staff felt supported, but they were not provided with supervisions in line with the providers procedure. We made a recommendation about supervision.

People and their relatives felt the care was safe. People received visits at the times they requested, and they knew which staff would be attending their homes. Staff stayed with people for the correct amount of time and met all their needs in a timely way. Staff had access to personal protective equipment and followed good practice to reduce the risk of the spread of infection.

People were treated with dignity and their privacy and independence was respected. Staff were clear of their responsibilities to maintain people’s confidentiality.

People’s healthcare needs were effectively assessed and monitored. The service worked with other healthcare professionals to assist people to maintain their health and wellbeing.

People knew how to complain and stated they had no complaints at present.

More information is in the full report below.

Rating at last inspection: Good (Report published 4 April 2018). This is the first time the service has been rated requires improvement.

Why we inspected: This inspection was brought forward due to concerns that had been raised with us.

Enforcement: We have asked the provider to send an action plan of how they will address the breaches in regulation. Full details are at the back of this report.

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.

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

Lilyrose Care Group Ltd is a domiciliary care agency. It provides care to people living in their own houses and flats in the community. It provides a service to young and older adults. At the time of the inspection the registered provider was providing support to 27 people.

At the time of the inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At the time of the inspection the registered provider was recruiting into the role of registered manager.

The registered provided ensured there was a number of different systems and processes in place to assess and monitor the quality and standard of the care being provided. People were receiving safe, compassionate and effective care and expressed that the provision of care was of a good standard.

During the inspection we reviewed care plans and risk assessments which were in place. Records were well maintained, contained up to date and relevant information and were regularly reviewed. Staff expressed that records enabled them to provide the level of support which was required and risks were always assessed, monitored, safely managed and communicated amongst the staff team.

Care plans were individually tailored and a ‘person centred’ approach to care was evident throughout the records we reviewed. People expressed that staff were familiar with their support needs and always provided care and support in a respectful and dignified way.

We reviewed medication management systems during the inspection. People had the relevant medication care plan in place which included detailed information in relation to medication administration times, medical history and the level of support required. There was a medication consent form which had been signed by each person who was being supported and staff had received the necessary medication training.

We reviewed the registered providers recruitment processes. All staff who were working for the registered provider had suitable references and disclosure and barring system checks (DBS) in place. DBS checks ensure that staff who are employed are suitable to work within a health and social care setting. This enables the registered manager to assess level of suitability for working with vulnerable adults.

Staff expressed how they were fully supported in their roles. Staff received regular supervisions and annual appraisals. Training was regularly provided as well as specialist training being offered to help support with learning and development..

Accidents and incidents were being routinely recorded and monitored. The registered manager ensured that accidents/incidents were being assessed and trends were being established. An ‘incident progress’ template had been devised and was updated accordingly.

We reviewed health and safety policies and procedures that the registered provider had in place. There was a health and safety policy that staff were complying with, staff were provided with personal protective equipment (PPE) and they were aware of the different health and safety risk assessments people had in place to support their health and well-being.

The day to day support needs of people was well managed by the registered provider. We saw evidence of appropriate referrals taking place, correspondence between external healthcare professionals as well as the necessary risk management tools being used to monitor people’s health and well-being.

The registered provider had suitable quality assurance audits, checks and assessments in place. Such measures ensured that people were receiving a safe level of care and support in relation to their support needs. Such audits, checks and assessments included ‘spot checks’, medication and care plan audits, ‘client review meetings’, ‘client surveys’ and environmental checks.

During the inspection we saw evidence of the different quality assurance systems which had been devised by the registered provider. Quality assurance tools ensured that the quality, standard and provision of care was being monitored, assessed and improved up on.

Policies and procedures were reviewed during the inspection. They contained relevant, up to date information and were available to all staff as and when they needed them. Staff were familiar with the area of ‘safeguarding’ and ‘whistleblowing’ procedures. Staff knew how to report any concerns and had completed the necessary safeguarding training.

The registered manager was aware of their responsibilities and understood that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures. Statutory notifications were being appropriately submitted in a timely manner.