Limms Care Services Limited

Updated 30 September 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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector. Another inspector contacted staff members to gather their feedback. An expert by experience contacted people and relatives to gather feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 22 August 2022 and ended on 23 August 2022. We visited the location’s office on 22 August 2022.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected about the service including notifications the registered manager had sent us. A notification is information about important events which the service is required to tell us about by law. Due to technical problems, the provider was not able to complete a Provider Information Return (PIR). 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. We used information gathered as part of monitoring activity that took place on 19 July 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager and interim quality and compliance manager and reviewed a range of records. These included seven people's care, support and other associated records. We also looked at a variety of records relating to the management of the service, including recruitment information for five staff, quality assurance, spot checks and observations, policies and procedures.

We contacted 15 people and/or their relatives. We spoke to four people and seven relatives.

After the inspection

We spoke to five staff team members. We looked at further information such as training data, policies and other service management records sent to us after the inspection. We sought feedback from the local authority and professionals who work with the service and received two responses.

Updated 30 September 2022

About the service

Limms Care Services is a domiciliary care agency that provides personal care to people in their own homes. It provides a service to people who have dementia, physical disability, learning disabilities or autistic spectrum disorder, as well as, older people. 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 inspection, there were 14 people using the service.

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

The registered manager did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards and identifying when the fundamental standards were not met.

The registered manager did not ensure consistent actions were taken to reduce the risks where possible and plans were not in place to minimise those risks. Effective recruitment processes were not in place to ensure that people were protected from staff being employed who were not suitable. The management of medicines was not always safe. Staff were not up to date with, or had not received, their competency checks and mandatory training. Staff did not have ongoing support via regular supervision and appraisals. Complaints were not managed effectively or according to the provider's policy. Not all people knew how to raise a complaint or concern with the provider or knew where the contact details were to raise a complaint.

When incidents or accidents happened, it was not recorded or clear that it was fully investigated, and if lessons were learnt. The registered manager did not ensure that clear and consistent records were kept for people who use the service and the service management. The registered manager did not inform us about notifiable incidents in a timely manner. Staff deployment and management of visits did not always ensure people received their care as planned. People and relatives were not consistently informed about the changes to their visits or the staff being late. People and relatives told us the times of visits were not always kept according to the care plan. People, their families and other people that mattered were involved in the planning of their care. However, the care plans did not contain information specific to people’s needs and how to manage any conditions they had. Staff did not have much detailed guidance for them to follow when supporting people with complex needs.

We have made a recommendation about seeking guidance from a reputable source to ensure the MCA legal framework and provider’s responsibilities to record people’s decisions was followed accordingly.

We have made a recommendation about seeking guidance from a reputable source to ensure the principles of the Accessible Information Standard were met.

People reported they felt safe with the staff providing their support and care. Relatives agreed they had no issues with people's safety. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. The staff team followed procedures and practices to control the spread of infection using personal protective equipment. People and their relatives who provided feedback said people were treated with care, respect, and kindness by the staff visiting them. Staff always upheld people's privacy and responded in a way that maintained people's dignity. People and relatives said that staff were consistent and effective in the support they provided. Staff said the staffing levels were sufficient to do their job safely and effectively.

We judged people were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests. However, the policies and systems in the service had to be improved to continue supporting this practice. The registered manager appreciated staff team’s contributions and efforts to ensure people received the care and support. Staff felt they could approach the registered manager at anytime, and they communicated regularly with each other. The staff team felt supported by the registered manager and worked well together.

The management team was working with the local authority and different professionals to investigate safeguarding cases and other matters relating to people’s health and wellbeing. There was an emergency plan in place to respond to unexpected events.

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 16 April 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.

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 quality assurance; risk management; notification of incidents; record keeping; management of medicine and complaints; staff training and competence and recruitment; staff deployment. We have made a recommendation about meeting the Accessible Information Standard and Mental Capacity Act legal framework.

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 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.