Laura Cares

Updated 6 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection the service had a registered manager in post.

Notice of inspection

This inspection was announced.

Inspection activity started on 26 May 2022 and ended on 31 May 2022. We visited the location’s office on 26 and 27 May 2022, we conducted telephone interviews with service users and their family members on 30 May 2022. We conducted telephone interviews with staff on 31 May 2022.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with three relatives, three people who used the service, four care workers, the registered manager who also acted as the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We looked in detail at three care plans, four staff recruitment files and the service’s staff training matrix. We spoke with four care staff which included a team leader and the registered manager. We looked at a variety of records relating to staff recruitment, medicine management, the management of the service, this also included the service’s policies and procedures. We sent emails out to staff requesting feedback. We received feedback from a health and social care professional and a local authority.

After the inspection

In response to our email request for staff feedback, we received two completed staff questionnaires. We continued to seek clarification from the provider to validate evidence found. All information received was used as part of our inspection.

Updated 6 October 2022

About the service

Laura Cares is registered to provide personal care and support to people in their own homes. 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. At the time of the inspection the service provided care and support to 35 people.

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

People were not always protected when potential or alleged abused had happened. This was because management were not aware of their individual responsibilities to prevent, identify and report all allegations of abuse. The service did not do all that was reasonably practicable to mitigate risks to people who were at risk of falls, living with dementia and had difficulty swallowing. There were unsafe recruitment practices, we have made a recommendation about this. People were safely supported with administration of medicines and from the risk of infection.

Assessments relating to peoples’ care and support needs did not fully factor the needs of people living with dementia and did not identify all of peoples’ protected characteristics as identified in the Equality Act 2010. People received care and support from staff who were not always inducted, suitably qualified, skilled and supported to meet their care and support needs. Appropriate referrals were made to relevant health and social care professionals to ensure people received timely care. We have made a recommendation in relation to staff supporting people with swallowing difficulties.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the registered manager did not work in accordance with the Mental Capacity Act 2005 and its Code of Practice.

People’s care was not always personalised and responsive to their needs and their preferences for end-of-life care were not captured. We have made a recommendation about this. The provider did not have effective systems to make sure all complaints were documented, investigated, and to ensure people were always provided with the outcomes. The service worked in accordance with the Accessible Information Standard and documented peoples’ communication needs.

The registered manager had lost managerial oversight of the service and failed to follow policies and procedures which, if followed, would have helped them to be compliant with the relevant legislations. Quality assurance systems were ineffective because the service’s internal audit processes were not able to identify when things went wrong and were completed by staff who did not have the skills to understand the significance of them. The service did not promote a culture that encouraged candour, openness and honesty at all levels when incidents happened. We have made a recommendation about this. Verbal feedback was sought but was not used improve the quality and delivery of care. The service did access external partners when necessary to improve the care outcomes for people.

People and relatives were very positive about the caring nature of staff. Comments included, “Very polite and helpful” and “They (staff) love her, they are so kind to her, they joke with her, we have a lovely relationship.” People and relatives told us they were treated with respect and dignity and their independence was promoted.

The registered manager was aware they needed additional support and had brought in another registered manager to assist them, as well as was seeking support from a local association, that supported registered providers.

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

Rating at the last inspection

This service was registered with us on 11 December 2019 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

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 multiple breaches in relation to person-centred care, how consent was obtained, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, notifying the Commission of incidents, good governance, staffing, fit and proper persons employed and Duty of Candour.

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.