Leda Homecare

Leda Homecare is a domiciliary care agency, providing personal care to 90 people 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

People were not always protected from harm, as safeguarding concerns were not always reported or analysed in an effective way. Staff and management knowledge of how to report safeguarding events was poor. Some staff had out of date safeguarding training.

There were risk assessments in place, however these were not always clear or comprehensive and not all risks had been identified or mitigated effectively.

There were gaps in medicine charts, so we could not be assured that people received their medicines in a safe way.

Several staff had training that was out of date, which meant staff did not necessarily have the training to support people in a suitable way. People were protected from the risk of infection.

Staff were recruited safely, and on most occasions, there were enough staff to meet people’s needs. However, both staff and people who used the service gave examples of times there were not enough staff, and relatives had to provide care.

Staff were kind and caring and respected people’s privacy and dignity. People told us staff treated them with respect. Staff were flexible around people’s social needs.

People’s needs were assessed, however there was a lack of nationally recognised tools to support initial and continuous assessment. Information gathered, around people’s wishes at the end of their life was basic.

Staff and management knowledge of the Mental Capacity Act was limited, and we could not be assured the service was working within the Act.

Complaints were not always handled in an appropriate way following the complaints policy.

Due to a lack of analysis of incidents and accidents, the opportunity to learn lessons and improve care were missed.

There was a lack of opportunities and procedures for staff and people to shape the direction of the service.

Quality monitoring and management oversight of the service was poor and audits in place were ineffective at identifying issues or promoting clear improvements.

We recommend that the service followed the complaints policy and responded formally to written complaints. We recommended that the service submit statutory notifications to CQC following serious incidents or safeguarding events where potential abuse is a concern.

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

The last rating for this service was good (last report published 12 September 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has begun to take action to mitigate the risks we found.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Leda Homecare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to; management of safeguarding issues; safe care; staffing; consent and governance of the service 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 inspection on 28 July 2016 the service was rated as Requires Improvement overall. We found medicines were not consistently managed safely as staff did not always have all the information they needed and did not always keep accurate records. There were no formal systems in place for auditing the overall quality of the service. Where people lacked the mental capacity to make certain decisions the service did not always work in accordance with the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to send us an action plan detailing how they would address the identified shortfalls, which they did. At this inspection we found the necessary improvements had been made and the service was no longer in breach.

A registered manager was 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.

Staff were appropriately recruited, trained and supported. They had undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting. Communication was effective and regular meetings were held to discuss issues and share best practice. Staff understood their roles and responsibilities and spoke enthusiastically about the work they did and the people they cared for.

Since the previous inspection the provider had implemented detailed policies and procedures relating to medicines management. Staff understanding and competency regarding the management of medicines was subject to regular monitoring checks and medicines training was updated appropriately.

Staff knew the people they were supporting and provided a personalised service and used effective systems for gaining consent. Individual care plans, based on a full assessment of need, were in place detailing how people wished to be supported. This helped ensure that personal care was provided in a structured and consistent manner. Risk assessments were also in place to effectively identify and manage potential risks.

Systems, implemented since the previous inspection, were in place to effectively monitor the safety and quality of the service and to gather the views and experiences of people and their relatives. The service was flexible and responded positively to people’s changing needs and any issues or concerns raised. People and their relatives told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

The service had a registered manager in place at the time of our inspection. 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.

We found that medicines were not always managed safely as staff did not always have all the information they needed and did not always keep accurate records.

People were supported by staff who knew how to recognise and respond to abuse and systems were in place to minimise the risk of harm. Risks associated with people’s care and support were effectively assessed and managed.

People had access to healthcare and people’s health needs were monitored and responded to. People were supported to eat and drink enough.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. There were sufficient numbers of staff available to meet people’s needs. Safe recruitment practices were followed and staff were provided with regular supervision and support.

Where a person lacked capacity to make certain decisions their rights under the Mental Capacity Act 2005 were not protected.

People who had capacity to make decisions were enabled to make choices about their support and were asked for their consent by staff providing care. People were encouraged to be as independent as possible.

Staff were kind and compassionate and treated people with respect. People’s rights to privacy and dignity were promoted and upheld. People were supported to raise issues and staff knew how to deal with concerns if they were raised.

People and their families were involved in planning their care and support and staff knew people’s individual preferences. People using the service and staff were involved in giving their views on how the service was run.

There were no formal governance systems in place to check the overall quality of the service. However, there were informal processes in place to monitor day to day aspects of service delivery.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to consent. You can see what action we told the provider to take at the back of the full version of the report.

People were involved with decisions relating to their care and support and their independence was encouraged. A person who used the service told us, "I've been involved right from the start, this company is absolutely smashing.'

The provider ensured people's needs were met and their care provided in an effective way. A person who used the service told us, 'They (care workers) really look after me well, they're lovely girls.'

People were protected from the risk of abuse. A relative we spoke with told us, 'We trust them (staff), I know we have to but you can tell that they love what they do.'

Staff received appropriate training and the quality of their work was regularly assessed. A care coordinator we spoke with told us, 'I have completed a lot of training in a number of areas. I am always happy to learn. The management are always happy to support us to progress. Staff here get a lot more training than in other organisations I have worked for.'

There were systems in place to monitor the quality of the service people received. The service was well led by the registered manager and director.