Lastminute Care & Nursing

Lastminute Care and Nursing is a domiciliary agency providing care to 134 people at the time of the inspection. People receiving a service required varying levels of support. Support packages ranged from short term domiciliary care to 24-hour support for people with ongoing mental health needs, autistic people and people with a learning disability.

A number of people requiring 24-hour support lived in 'supported living' services. People held an individual tenancy for their bedroom and shared communal areas such as lounges and kitchens. Each 'supported living' service had designated space for staff to store their belongings, maintain records and provide sleeping in support.

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

We found sufficient improvements had been made to ensure the provision of safe care; the service was no longer in breach of regulations. A high turnover of staff and management within the ‘supported living’ services had continued to be a factor since our last inspection. Although we saw this had improved, some people receiving support, relatives and professionals expressed concern about the impact this had on the ability for the provider to deliver consistent care. We sought assurances and the provider evidenced plans to address this.

We have also made a recommendation about maintaining induction records for new staff.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Since the last inspection the provider had reviewed its policies and procedures in line with these principles; the support needs of people had been appropriately assessed and planned. People were treated with dignity and respect and staff working for the service were committed to providing person centred care. People spoke positively of the care they received.

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.

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 08 April 2021) and there were multiple breaches of regulation. 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.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Lastminute Care and Nursing is a domiciliary agency providing personal care to 130 people at the time of the inspection. People receiving a service required varying levels of support. Support packages ranged from short term domiciliary care to 24-hour support for people with ongoing mental health needs, autistic people and/or people with a learning disability.

A number of people requiring 24-hour support lived in ‘supported living’ services. People held an individual tenancy for their bedroom and shared communal areas such as lounges and kitchens. Each ‘supported living’ service had a designated room for staff to store their belongings, maintain records and in some cases, provide sleeping in support.

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

Governance systems to monitor the quality of care being delivered to people required improvement. Existing systems failed to always identify shortfalls in care planning, recording and staff training.

Accident, incident and safeguarding processes needed to be improved to ensure incidents were reported in accordance with local authority safeguarding procedures and the Care Quality Commission (CQC) in a timely way.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Not all people’s support needs had been appropriately assessed or planned. There had been a high turnover of support staff in recent months as well as a number of changes in management. This meant several staff lacked the necessary skills, knowledge, supervision and information needed to support people in a safe and consistent way. Some people had not always been able to choose who they lived with.

These issues had created a number of avoidable incidents between people and had placed a small number of people receiving support at the risk of harm. This did not affect the entire service provision and the issues we found specifically related to people within some of the supported living services. The provider was working with the local authority to ensure people were happy with who they lived with, to ensure staff had the training they needed; and to ensure people had an appropriate plan of care in place.

We found other people did have appropriate support plans in place and these reflected external professional input. In these cases, 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. Although, the policies and systems in the service supported this practice, we have made a recommendation for the manager to review existing support plans and documentation to ensure all decisions made in people’s ‘best interests’ remain the least restrictive option available.

We have made recommendations to ensure the provider can evidence people’s involvement in support plans and to review the service user guide so it was available in an ‘easy to read’ format.

Although we identified some issues in this inspection which required improvements to be made, people receiving support and the majority of relatives spoke positively of the support from staff and told us people were supported by staff who were caring and responsive to their needs. People could pursue their interests and hobbies and could change aspects of their support if their circumstances changed.

Staff spoke warmly of the people they supported and staff were committed to delivering high quality care. A new manager had been appointed to support this.

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 5 July 2019. We completed a focused inspection (published 14 October 2020) and looked at the key questions of Safe and Well-Led. These key questions were rated good, however did not enable us to provide the service an overall rating. This is the first inspection to cover all five key questions.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being delivered, staff skills to meet people’s needs, poor infection, prevention and control measures during the COVID-19 pandemic, management inconsistency and lack of transparency when incidents of concern arose. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the 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 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 staff training, reporting allegations of abuse, safe care and treatment 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.

Lastminute Care and Nursing is a domiciliary care service providing personal care to 52 people at the time of the inspection. The level of support people needed ranged from short visits to 24- hour support either within private homes or supported living services. 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.

The support living services provided care and support to people who had a learning disability and/or autism and had been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support. People shared communal facilities within the properties such as bathrooms, kitchens and living areas and the houses were situated in residential areas with access to regular public transport links, shops and leisure facilities. This meant people were supported to maximise their independence, choice, control and involvement in the community.

People’s experience of using this service and what we found

Staff were recruited safely; however some details were not easily accessible. The provider took steps to address this and improve the systems for storing recruitment records.

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.

At this inspection, we were unable to fully assess whether the service was applying the principles and values of Registering the Right Support and other best practice guidance. This is because we completed a focused inspection which meant we didn’t inspect every aspect of a persons’ care and support. These principles ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. We found however, that people were offered choice, encouraged to be as independent as possible and led active lives. We were also consistently informed by relatives that people receiving support were happy and had developed positive relationships with their staff teams.

Medicines were managed safely, and systems were in place to manage risks to people’s health and wellbeing. This included any risks relating to the current Covid-19 pandemic. Staff had access to and wore the correct personal protective equipment (PPE) and the risks to people who experienced difficulty in their staff wearing PPE such as facemasks had been considered in support plans.

The service was well-led. There had been several management changes in recent months however the provider had maintained a good level of oversight during this period . There was a clear vision in place for the service moving forward. Where issues had been raised, the provider demonstrated a clear commitment to resolving these and a willingness to listen to the views of others.

Staff felt well supported by an open and honest culture. The provider also worked with other professionals and organisations to ensure positive outcomes were achieved for people.

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 05 July 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the number of management changes within the service since its registration. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

We found no evidence during this inspection that people were at risk of harm. Please see safe and well led sections of this full report.

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.