LAM Care 24 - Derby

LAM Care 24 - Derby is a domiciliary care agency and supported living service. The service provides personal care to older and younger adults who may be living with a range of needs including dementia, mental health, learning disabilities, autism, and physical and sensory needs. At the time of our inspection there were 18 people using the domiciliary care service. There were 5 people who used the supported living service in 2 separate houses.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting underpinning principles of “Right Support, Right Care, Right Culture.

Right support:

Care staff had the skills and knowledge to safely meet people’s needs. Processes were followed to help the provider recruit staff who were suitable to work in care. People and their relatives were involved and engaged in their care.

Right care:

People received care that promoted their safety and risks were reduced. Medicines were administered in line with good practice. Infection prevention and control measures were followed to help reduce the risks from infection.

Right culture:

Care staff provided person-centred care and people experienced good outcomes from their care. The service aimed to continually improve and learn lessons. People and staffs’ views were valued and used to develop the service. Audits and checks on the quality and safety of services were completed regularly.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 May 2021).

At our last inspection we found a breach of the regulation in relation to the systems used to assess and monitor the quality and safety of services. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We carried out an announced comprehensive inspection of this service on 19,20,21 October and 16 November 2020. A breach of legal requirements was found in relation to the systems used to assess and monitor the quality and safety of services.

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions safe and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for LAM Care 24 - Derby on our website at www.cqc.org.uk.

Follow up

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

LAM Care 24 – Derby provides support to people in their own homes within Derby and Derbyshire. The service caters for older people and younger adults with needs relating to dementia, learning disabilities, physical disabilities, and sensory impairment. 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 our inspection 21 people were receiving personal care and support. LAM Care 24 – Derby also provides supported living service. At the time of the inspection the supported living service was providing support to two people only one person was receiving personal care.

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

The quality monitoring systems in place had not always identified when improvements were needed. At this inspection we found improvements were required in recruitment practices, to ensure all the required pre-employment checks were in place prior to new staff commencing employment. The management of medicines was not consistently effective. Care records contained inconsistent, and at times contradictory information, this posed a risk to the safety and quality of care provided.

People and relatives told us they liked the staff, they felt safe with the care and support delivered and received support from a regular team of staff. There were systems to monitor whether calls took place on time and as planned. Staff had received training and understood the procedure to follow to protect people from abuse.

People and their relatives were involved in agreeing and reviewing their care plans.

Care workers were positive about the registered manager and stated that they received the required training and support to carry out their role.

People and relatives spoke positively about the way in which the service was managed. People's views were sought on the service they received, to enable the provider to make improvements if required.

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

Rating at last inspection

The last rating for this service was Good (published 10 October 2018).

Why we inspected

The provider had put themselves forward to be part of the DCA virtual inspection pilot being carried out by CQC. However, during the pilot inspection, we identified concerns around medicines management and reverted to a focused inspection. We undertook a focused inspection to review the key questions of safe and well-led only.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this 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. During the writing up of the report the provider submitted an action plan to address the issues identified at this inspection.

LAM Care 24 is registered to provide personal care. The registered location is situated in Derby and provides care to people who live in their own homes in and around Derby and Derbyshire. The service caters for older people and younger adults with needs relating to dementia, learning disabilities, physical disabilities, and sensory impairment. There were 29 people using this service at the time of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

People using the service and their relatives were positive about the service they received and of the care staff and management team who supported them daily.

Care Staff were aware of their responsibilities for keeping people safe from avoidable harm or abuse. They had received training on the safeguarding of adults and were aware of the procedures they needed to follow should they have concerns about people’s welfare. The management team were aware of their responsibilities for keeping people safe and knew to refer any concerns on to the local authority and Care Quality Commission (CQC).

People had been assessed and the risks associated with their care and support had been identified, reviewed and managed. Care staff received training in the prevention and control of infection and the necessary personal protective equipment was readily available.

There were enough staff employed by the service to support people safely. Care staff were punctual. If staff were running late the office would let people know or would send an alternative carer to ensure they received their care on time. Staff were recruited following a safe recruitment process to make sure only suitable people worked at the service.

Care staff received an induction and training programme, which ensured they were well trained to meet people’s individual needs and work in line with the service’s ethos. People told us they thought the staff were well-trained. The care staff we spoke with were knowledgeable about the people they supported and how best to meet their needs. Training records showed that staff had completed a variety of courses to give them the skills and knowledge they needed to support people effectively.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to sustain and improve safety across the service.

People were supported to choose the food they liked. Staff supported people to maintain good health and access healthcare services when they needed to. Staff understood the importance of monitoring people's well-being and told us what they would do if they had concerns. This included liaising with healthcare professionals and accompanying people to healthcare appointments where appropriate.

People told us the care staff were extremely kind and caring and they were treated with respect. They told us their care and support was provided in a way they preferred and their consent was always obtained. The care staff supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected. We have recommended that MCA assessments are more detailed and follow best practice guidance.

People's preferences as to how they wanted their care and support provided were recorded in their care plans. This meant staff had the information they needed to ensure people received personalised care in line with their wishes. Care plans were reviewed regularly and updated so staff were aware of people's changing needs.

People said they knew how to make a complaint if they needed to. The provider's complaints policy was in the service user guide and told people what to do if they wanted to complain.

People using the service, relatives and staff told us they would recommend the service to others. They told us the provider listened to them and made changes where necessary to improve the service.