Limms Care Services Limited

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.