Lizor Care

Lizor Care Concept is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 71 people using the service.

Not everyone who used the service received personal care. The Care Quality Commission 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

The provider has a poor history of compliance with regulation. There have been 5 inspections since the provider’s registration in May 2020. All inspections have been initiated due to safeguarding concerns or to follow up on shortfalls identified at a previous inspection. As a result of the inspections, we have issued requirement notices and a warning notice, to ensure the provider made improvement. At this inspection the provider remained in breach of regulations.

Risks people faced had not been identified, assessed or mitigated. This included the risk of choking, skin soreness and fire hazards when using petroleum-based emollients. Recommendations from specialised professionals such as the epilepsy nurse, had not been added to people’s care plans. This did not ensure staff had the knowledge to support people safely.

Medicines management remained unsafe. Staff had not given a person their prescribed medicine for four days and, once identified, they had not sought medical advice. This put the person at risk of harm. Guidance for staff regarding people’s medicines was not always clear or accurately documented. This meant people were at increased risk of experiencing harm from avoidable medicines errors.

The provider had made some improvement to staff recruitment, but shortfalls remained. Applicants had not always given a full employment history and the performance of one applicant had not been verified. These shortfalls did not clearly evidence the applicants were suitable for their role, which placed people at risk of harm.

Care planning was task orientated and not always person centred. The information did not show how a person’s health condition, such as dementia impacted, on them. Techniques staff should use to best support a person were also not identified. This did not ensure a consistent staff approach to effectively meet people’s needs.

Systems did not effectively monitor the performance of staff. For example, records showed one member of staff required more supervision, but there were no records to demonstrate this. There was no assessment of the staff member’s competence to show they were able to carry out their role effectively. This did not ensure people were supported effectively.

Whilst people and their relatives knew how to raise a concern, records did not evidence a well-managed complaint procedure. The provider was not able to provide evidence of the complaints raised, their investigation or outcome. This did not demonstrate all complaints were addressed or that lessons had been learnt.

There were some auditing systems, but these did not always identify shortfalls in the service. This included those shortfalls found at this inspection, such as staff recruitment and supervision, the safe administration of medicines and risk management. Audits of daily records, care plans and medicines had been completed, but the information had not been used to give an overview of service provision. For example, some lateness of people’s support had been identified, but not analysed to show any patterns or trends. This did not ensure action was taken to improve provision.

Staff had been recruited via the government’s staff sponsorship scheme. The scheme had ensured there were enough staff to support all care packages and had enabled the size of the agency to grow significantly. The provider had divided all staff into teams based on the geography of where they worked. A team leader for each team had been employed, to ensure better overview.

People were happy with the infection control practice staff followed. This included wearing the appropriate personal protective equipment and keeping areas of their home clean. Records showed staff had received training in infection prevention and control.

At our last inspection we recommended that the provider revisited the safeguarding training staff received, and ensured staff were competent to apply their learning in their practice. This recommendation had been acted on and systems were in place to minimise the risk of people sustaining abuse. People felt safe with staff supporting them and were complimentary about the service they received. They said they generally had a consistent staff team, who usually arrived on time and stayed the full allocation of their visit.

Rating at last inspection and update

The last rating for this service was requires improvement (published 05 January 2023) and there were breaches in regulation. This service has been rated requires improvement for three inspections since registration. At this inspection we found the provider remained in breach of regulations and has been rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about the number of safeguarding notifications we had received from the local authority and other agencies. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

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

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, the safe administration of medicines, staff recruitment, person centred care and good governance.

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 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 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 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 timeframe 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.

Lizor Care Concept is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 20 people using the service.

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’s medicines were not always safely managed. This was because guidance for staff was not always clear. This meant people were at increased risk of experiencing harm from avoidable medicines errors.

The provider failed to ensure robust recruitment procedures were followed. This meant the provider could not be assured prospective staff always had the required skills and competence to support people safely. The provider told us they had enough staff to support existing care packages although this was not the experience of some people. Overall, people received their visits on time, however people told us they were supported by an inconsistent staff team.

Whilst some auditing had been developed, shortfalls in the service were not always being identified. This included areas such as the administration of people’s medicines and care planning documentation. For example, the electronic monitoring system highlighted if staff had not arrived to support a person, so action could be taken. However, an analysis of such concerns had not been considered. This did not give an overall picture of the frequency or circumstances of these situations, and therefore any action required as a result.

Systems were in place to help protect people from the risk of abuse. However, an incident had recently occurred, which placed a person at risk of significant harm. The provider apologised for this and assisted the local safeguarding team with their investigation as required.

Focus had been given to the assessment and management of risk, which enhanced safety. Staff had received training and knew how to safely use equipment people had in their own homes. People and their relatives confirmed staff’s confidence and competence in this area. The provider had a willingness to learn, and showed they would address shortfalls once brought to their attention.

People told us they felt safe and were satisfied with the support they received. They said positive relationships had been established with some of the staff and their rights were promoted. People told us the service was reliable and they had their care regularly reviewed. They were encouraged to give their views and told us management were always available and addressed any concerns they might have.

Staff felt supported, and were able to gain advice at any time. They had received training to help equip them to undertake their role effectively. This included topics such as dignity, communication and equality and diversity, which promoted a positive culture.

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 27 May 2022) and there were breaches in regulation. We issued a Warning Notice in relation to good governance.

In June 2022 we completed a targeted inspection to check whether the Warning Notice had been met. We found improvements had been made and the Warning Notice had been met.

At this inspection we found the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 27 May 2022). The service was also rated requires improvement at the inspection in March 2021. The service remains rated requires improvement. This service has therefore been rated requires improvement at three out of four inspections.

Why we inspected

We received concerns in relation to a person’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Once aware of the concerns, the provider apologised, took appropriate action and worked with the local safeguarding team.

You can see what action we have asked the provider to take at the end of this full report.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Lizor Care Concept is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 17 people using the service. 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

Improvements had been made to the medicines recording systems since the last inspection. Medicines administration records had been fully completed and gave details of the medicines people had been supported to take.

The provider had worked with the supplier of their electronic records systems to understand ways they could resolve their recording issues. Staff had been provided with additional training on the medicines recording systems following this, to ensure they understood what they needed to do to maintain accurate records.

At the last inspection people told us they received good support from staff to take their medicines. We did not seek further feedback from people at this inspection, because our concerns at the last inspection related to the records staff kept, rather than the care people received.

The manager had developed a series of audits, to assess how key aspects of the service were operating. These included assessments of the medicines management systems, care planning, risk assessments and observations of staff practice. Records demonstrated these audits had identified shortfalls in the way some systems were working and identified how improvements could be made. Actions from the assessments had been followed through to ensure improvements were implemented by all staff.

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 20 May 2022)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lizor Care Concept is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 18 people using the service.

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

Systems had not been established to consistently assess and manage the risks people faced. This placed people at risk of harm. Assessments did not contain specific information about people’s injuries or risks of developing pressure ulcers. There was no information for staff about the signs they should monitor for a deterioration in people’s condition.

There was not an accurate record of the medicines staff had supported people to take. The systems in place for staff to record when they supported people with their medicines did not work effectively. This increased the risk that people would not receive their medicines in the way they were prescribed.

The service was not well managed, and the provider did not have effective systems to monitor and improve the service. The systems had not identified some of the shortfalls we found during the inspection. The service did not have a registered manager. The provider had not notified us of significant events, which they are legally required to. The provider had not made all of the improvements identified as necessary at the last inspection.

People felt staff had the right skills to meet their needs and were kind and caring. People said staff provided care in ways that respected their privacy and dignity.

The service had improved their infection prevention and control measures since our last inspection. Staff were being tested in line with current government guidance. People said staff followed good hygiene procedures to help prevent the spread of COVID-19.

Staff said they received the training and support necessary to provide the care people needed. Staff felt they could receive additional support and were able to contact the management team when needed, including out of office hours.

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 8 May 2021) and there were breaches of regulations. 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 the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements. Please see the safe 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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to managing risks, keeping accurate records of care provided, management oversight of the service and notifying CQC of significant events at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Lizor Care Concept is a domiciliary care agency providing personal care to people who live in their own home. 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 23 people were receiving personal care.

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

The provider did not have effective systems to identify and manage the risks people faced. There was a lack of information about how staff should support people who used specialist medical equipment, or the support people needed when they were distressed due to the impact of living with dementia. Staff did not always keep clear records of incidents that occurred or identify when people were making allegations of abuse.

The provider had not followed government guidance on regularly testing staff for COVID-19, which increased the risk that staff may transmit COVID-19 to people.

People were not supported to have maximum choice and control of their lives and the provider could not demonstrate decisions were made in people’s best interests; the policies and systems in the service did not support this practice.

The governance systems were not effective at identifying shortfalls in the service provided or planning how to make improvements.

Staff respected people’s privacy and dignity. People felt staff treated them well and were comfortable with staff in their home.

People were supported to prepare food and drinks where needed, ensuring this met people’s needs and minimised identified risks. Staff worked with health teams to ensure people were able to access the services they needed.

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 14/05/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing arrangements, infection prevention and control and management of the service. A decision was made for us to complete a comprehensive inspection and examine those risks.

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.

Follow up

We will request an action plan from 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.