LIM Independent Living and Community Care Services Limited

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

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 are living with a learning disability and/or autism.

Right support

The provider did not plan people’s care in a personalised and person-centred way or plan for when people experienced periods of distress. There were no specific risk assessments in place for people. This meant there was not sufficiently detailed information for staff about the risks to people and how to safely manage them. People’s medicines were not administered safely. We found no evidence anyone had been harmed. However, the lack of specific and detailed risk assessment information for staff and the provider’s failure to follow guidance for medicines management put some people at increased risk of potential harm.

The provider enabled people to access specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing. Staff supported people to have the maximum possible choice, control and independence.

Right Care

Not all staff understood how to protect people from poor care and abuse and the provider lacked knowledge of how to work with other agencies to do so. The provider did not deploy enough appropriately skilled staff to meet people’s needs and keep them safe. People’s care, treatment and support plans did not reflect their range of needs. The provider did not assess risks people might face. We found no evidence anyone had been harmed. However, the lack of safeguarding knowledge, detailed information about people’s needs and risk assessments put some people at risk of potential harm.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

People were not supported by a registered manager and staff with a good understanding of best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. The provider did not sufficiently evaluate the quality of support provided to people. The service did not have a person-centred culture or a culture of learning and improvement.

Staff knew and understood people well and were responsive. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes and needs at the heart of everything they did. People and those important to them, were involved in planning their care. Staff valued and acted upon people’s views.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 September 2019) and there were breaches of regulation. This service was rated requires improvement for the last 3 consecutive inspections. At this inspection we found the provider remained in breach of regulations and the rating for this service has changed to inadequate.

Why we inspected

We carried out an announced comprehensive inspection of this service on 11 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the effectiveness and governance of the service.

We undertook a focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there were concerns with the safety, effectiveness, responsiveness and governance of the service, so we widened the scope of the inspection to become a comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for LIM Independent Living and Community Care Services Limited on our website at www.cqc.org.uk

We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, person-centred care, staffing, safeguarding, recruitment, registered manager requirements and governance at this inspection.

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 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 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.

LIM Independent Living and Community Care Services Limited is a service providing personal care to people in their own homes. The service supports older people who need help with personal care. Twenty-two people were in receipt of care at the time of the inspection.

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 staff did not always receive regular training to keep their knowledge current nor regular supervision to support them in their role.

While some people were happy with their visit, other people raised concerns about lateness, missed visits and not being informed when visits were late.

The provider oversaw the service with a system of checks and audits to ensure standards were maintained. However, these checks and audits had not identified and resolved the issues we round relating to staff training, supervision, lateness, missed visits and communication about lateness and cover arrangements.

People received medicines safely. The provider assessed risks to people, including those relating to medicines, and took action to reduce the risks. Staff followed best practice in relation to infection control. There were enough staff to support people safely and people received care at the agreed times.

People received the support they needed to maintain their day to day health and in relation to eating and drinking. 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 described staff positively and developed good relationships with them. People received consistency of care from staff who knew them well. Staff treated people with dignity and respect and encouraged them to maintain their independence. People were involved in their care and also in developing their care plans. People’s care was personalised to meet their needs and preferences. People’s communication needs were met. The provider responded to complaints appropriately.

An experienced registered manager was in post who was also a director of the company. People, relatives and staff told us the service was well-led and the provider engaged with them. The provider submitted notifications of significant incidents to CQC as required by law.

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 requires improvement (report published August 2018). This service has been rated requires improvement for the third consecutive time.

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Enforcement

We have identified breaches in relation to the regulations about staff support 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last announced comprehensive inspection of this service on 8 January 2018 we identified issues relating to safe care and treatment, consent, person-centred treatment and good governance. We served the provider warning notices in relation to safe care and treatment and good governance which required the provider to be compliant by 5 April 2018. We rated the service ‘requires improvement’ overall. We carried out this inspection to check the provider was compliant in relation to the warning notices as well as with all other fundamental standards.

The service is a domiciliary care agency. It provides personal care to people living in their own homes, flats and specialist housing. It provides a service to older adults and younger disabled adults. There were 101 people receiving personal care from LIM Independent Living and Community Care Service at the time of our inspection.

The service had a registered manager in post. The registered manager had been in post since the service registered with us in 2012 and was also the director. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider had not always submitted statutory notifications of significant events to CQC as required by law. This meant the provider did not always support us to monitor the service and plan inspections.

The provider did not always inform people and relatives if staff were going to be late and people were unhappy with this.

The provider had improved in relation to the concerns we found at our previous inspection.

People’s medicines were managed safely and the processes to assess and manage risks relating to people’s care were more comprehensive.

Care plans contained more information about people’s needs and preferences with clearer guidance for staff to follow in caring for people.

The provider had systems to assess the mental capacity of people in line with the MCA and make decisions in their best interests.

Most people told us they received care in a timely manner and the provider used an electronic system to monitor timekeeping. The way the provider used the electronic system to monitor timekeeping had improved since our last inspection.

The provider improved the way they responded to and used concerns and complaints to improve the service.

The provider had systems to assess, monitor and improve the service. Records relating to people, staff and the overall management of the service had also improved.

There were enough staff deployed to meet people’s needs and staff were recruited using suitable recruitment checks. People received care from staff who were suitable for them.

People felt safe with the staff who supported them and staff understood how to respond if they suspected anyone was being abused to keep them safe.

People received food of their choice and received any support required in relation to eat and drink. People also received support with their day to day health needs.

People liked the staff who supported them and staff treated people with dignity and respect. Staff were allocated sufficient time to care for people.

At our last announced comprehensive inspection of this service on 27 November 2015 we rated the service ‘good’ in all five of the key questions we ask of services. At this inspection we found the service had deteriorated and rated them ‘requires improvement’.

LIM Independent Living and Community Care Service is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. There were 22 people receiving services from LIM Independent Living and Community Care Service at the time of our inspection.

The service had a registered manager in post. The registered manager had been in post since the service registered with us in 2012 and was also the director. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider did not assess risks relating to people’s care through a suitable risk assessment process. This meant the provider could not be assured they were managing people’s risks well. The provider had not assessed risks relating to people’s care including those relating to medicines management and those relating to people’s medical and health needs.

In addition the provider did not have care plans in place to inform staff about some people’s individual needs and the best ways to care for people in relation to these. The provider gathered information about people, including their needs and preferences before they began providing care. However, the provider did not use this information to inform care plans to guide staff on the best ways to care for people. Care plans consisted only of sheets where the tasks people required were ticked. The provider did not put care plans in place to provide staff with information and guidance about people’s physical, mental, emotional and social needs. This lack of information impacted on the ability of staff to provide person-centred care.

The provider had not carried out MCA assessments to determine whether people lacked capacity when they had reason to suspect this. The provider had also not followed the MCA in making decisions in people’s best interests as they had not determined if any people lacked capacity in the first instance.

People were not supported to receive timely care and support through technology in place. The provider invested in an electronic system to track the times people received care. However, we identified staff were misusing the system so it was not possible for the provider to track the times reliably. Although people and relatives told us they had never received a missed visit, three relatives said timekeeping was an on-going issue. The provider had not ensured staff used the electronic system reliably to help them understand and improve issues relating to lateness.

People’s care was not always scheduled well as the provider scheduled several people to receive care at the same time by each staff member. This meant people experienced lateness and staff experienced unnecessary pressure.

The provider did not also use concerns raised by people to improve the service, particularly in relation to concerns raised regarding lateness. In addition, the provider did not always respond to complaints promptly. We have made a recommendation about the management of complaints.

The provider had poor governance processes to assess, monitor and improve the service. This meant the provider had not identified the issues we found during our inspection. In addition the provider did not ensure robust recording processes in relation to people using the service, staff and the overall management of the service. For example, the provider was unable to show us evidence of the training and support and supervision staff had received due to poor records. In addition, the provider did not always retain the necessary documentation on file regarding staff recruitment.

There were enough staff deployed to meet people’s needs. People felt safe with the staff who supported them and staff understood how to respond if they suspected anyone was being abused to keep them safe.

People told us they received the support they needed regarding eating and drinking and their day to day health needs.

People were generally supported by staff chosen to match their needs and preferences. However, the lack of a system to accurately record people’s needs and preferences meant sometimes people received care from staff who were unsuitable for them.

Staff treated people with kindness and dignity and respected their privacy. People were positive about the staff who supported them. People received the care they wanted and were involved in their care. Staff were allocated sufficient time to care for people.

The provider had systems to communicate with people, relatives and staff but these were not always effective. The provider worked in partnership with key organisations in a transparent way.

We found breaches of the regulations relating to safe care and treatment, consent, personal care and good governance. We have taken enforcement action against the provider in relation to the breaches of safe care and treatment and good governance which you can read about at the back of our full-length report.

As part of our inspection we spoke with several people who use the service and or their family members by telephone. The feedback we received about peoples care and support was generally positive. One person told us 'Overall I am very happy with the service. The carers that visit are all very kind and support my relative well". Another person told us 'The carers are very good. Any concerns I have had have always been addressed and resolved'.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people's family members fully involved. People who use the service told us that they knew who to speak with if they had a concern or complaint and they had been given information on the complaints process.

People experienced care, treatment and support that met their needs and protected their rights. We looked at care records and support plans for three people using the service. Care plans we examined were person centred and contained detailed guidance for staff on how to support people who use the service in all areas of their daily lives. There were effective recruitment and selection processes in place, and appropriate checks were undertaken before staff commenced work.

People who use the service were given appropriate information and support regarding their care and support. Their care records showed that their needs had been assessed by the agency's staff and care plans drawn up accordingly. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The manager confirmed that people's needs were re-assessed when there were changes.

We were told that all staff had regular supervision which allowed them to discuss their performance and any individual training needs that they might have.