Archived: Lancaster

After the inspection in December 2015, we received further concerns about missed and late visits. We also received information of concern regarding the disposal of important records. As a result, we undertook a further focused inspection on 03, 09 and 15 March 2016.

We undertook this focused inspection to assess if people were safe. The visit on the 03 and 09 March was unannounced. The provider was notified prior to our visit on the 15 March 2016. This report covers our findings in relation to this inspection only. You can read the report from our last inspection by selecting the 'all reports' link for Lancaster on our website at www.cqc.org.uk.

At this inspection we judged the provider continued to be in breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment and Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Good Governance. The service was also in breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Person Centred Care and Regulation 18 Care Quality Commission (Registration) Regulations 2009 Notification of other incidents.

Lancaster is registered to provide personal care to people living in their own homes. At the time of our inspection, 31 people were receiving a personal care service. The office is based at Riverway House, which is situated between Lancaster and Morecambe. The service provides care and support for older persons, dementia care, end of life care, long-term conditions, respite care and night care.

There is a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection, we looked at electronic systems and documentation that showed not all people who required support receive their scheduled visits. This left them at risk, because the provider did not provide the care and treatment identified to meet people’s needs.

Records we looked at showed people who required a service did not always receive their allocated support time. We saw that the length of time carers were due to stay with people as part of a scheduled visit had been shortened to allow staff to complete additional visits elsewhere.

We saw examples of where people who were scheduled four visits a day, had received three visits because two of the visits had been merged. This placed vulnerable people at risk. They did not receive safe and effective support with their physical and mental health requirements.

Risks were identified with the electronic monitoring system. The system was not effective as it did not always show when visits had not occurred. When the system did show missed visits, the staff member operating the system was unable to explain why they had occurred.

People were not given the support they needed with medicines as directed within the care plans.

Ongoing medical conditions were not managed safely.

Care plans identified risks, although information was brief and lacked detail to guide staff on how to manage the risk. This placed people at risk of harm.

There were safeguarding policies and procedures in place. We saw the provider had raised a safeguarding concern with the local authority in relation to theft. They had not notified the Care Quality Commission as required.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we looked at the systems the agency had in place to keep people safe and well. We looked at care plan records and risks assessments, safeguarding systems in place, management of medication, staff recruitment and induction training, the quality monitoring systems and how complaints were managed by the agency.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

Following a recent safeguarding meeting, the agency had devised a policy and guidance for staff to follow when supporting people who may lack the capacity to make decision regarding their care and support. The management team had recently attended training to develop their skills and knowledge in this area. We discussed with the provider the need to embed this learning and practice within the care and support they provide. The provider told us they would review their care plans to ensure mental capacity assessments are incorporated into their support plans.

We looked at several care plan records to show us how the agency supported people to remain safe and well in their home. Information in the care plans identified the care and support people required. The agency worked with a range of external professionals to meet people`s needs. Care plan records and risk assessments were regularly reviewed.

All staff had attended recent safeguarding training. Our discussions with staff confirmed they were aware of their responsibilities to report any concerns if they suspect someone is at risk of harm or abuse.

Is the service effective?

People's health and care needs were assessed, monitored and reviewed. The agency worked in partnership with other professionals. We received some positive comments from people. One person told us, 'My family member is really happy with the agency and feels it is the best thing that has happened to her. If there are any problems they don`t hesitate to contact us.'

Is the service caring?

Staff we spoke with told us they felt well supported and enjoyed their work. They appeared to be caring and enthusiastic. Our discussions confirmed staff were knowledgeable regarding people`s needs and what actions to take if they had any concerns.

We saw documentation to show that staff completed daily records of their visits, and daily food and fluid charts. However the food and fluid charts and daily records we read were fairly basic. The Care Manager told us he would ensure that staff completed more detailed records by documenting what people actually ate and drink, and whether they required additional support to eat and drink. One person we spoke with told us, 'I have been with the agency for a few months and they are a lot more on the ball. They help me at mealtimes and we have been bouncing ideas off to help me with seasonal variations with my meal planning. They are very encouraging'.

Is the service responsive?

Staff told us they regularly support people with Dementia type conditions. They told us their dementia training assisted them to meet the needs of people. Staff told us that the agency carried out spot checks and visits in people`s homes to gain feedback from people and to check that the care plan records were completed properly.' One person told us, 'Generally the girls are very good. They are diligent, reliable and honest and that`s all we want. Sometimes the staff change when people don`t turn up or go off sick. However since I rang the office a few weeks ago they do try to ring and let us know.'

Staff were now attending annual e- learning refresher training in the management of medicines. We saw records in the staff files that indicated staff had recently undertaken and passed this training. We spoke with several members of staff. Our discussions confirmed they were aware of what actions to take to promote people`s health and well- being and what actions to take if they had any concerns.

Is the service well-led?

The agency had a range of systems in place to monitor the quality of the services being provided. They had introduced a new out of hours service to improve the communication with clients and their families. This benefited staff too, by giving them a dedicated resource for advice and guidance.

The agency had safe recruitment processes in place and had recently recruited new staff to the team. There was a recently appointed Care Manager in post who was being supported to develop their role. We saw evidence to show how he had responded positively to concerns and action taken to make improvements with the services they provide.

When we spoke with people who used the agency they told us told us they managed their own medication. One person commented, `I can do my medication myself, I use blister packs. I would say if I had any problems. I am quite happy`. Our discussions with staff confirmed they were clear about their role and what action to take if they had any concerns regarding the safe use of medication.

At the last inspection there were concerns that related to the safe recruitment of staff. We found all relevant checks were undertaken before new staff members commenced their employment.

Since the last inspection we saw evidence that the manager had improved their procedures to monitor the quality of the service being provided. There were regular care plan reviews taking place and the management team had oversight of the review process.

The agency had a complaints procedure and a copy was made available to people in their individual care plans. The provider maintained records of complaints in the main office as an audit trail of complaints and concerns with actions taken.

The four care plan records we looked at contained accurate and up to date information. The files were planned and organised in a consistent way.

People told us; there have been hiccups but they've ironed them out`.

`I can't fault them, I can relax and let them get on with the job`.

`It makes you feel the job isn't just going in and making cups of tea. It is a very important job`.

Staff told us they felt supported and there was always someone on the end of the phone.