24 August 2023
During a routine inspection
Livingstone Care Office - Innovation House is a domiciliary care agency providing personal care to people in their own homes, who were at the end of their lives or may be living with dementia or other health conditions. 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 the service was providing personal care to 36 people.
People’s experience of using this service and what we found
Risks to people's health and safety where identified. However, guidance on what action to take if the risk occurred was not consistently recorded. There was a failure to fully assess and mitigate risks to some people. Care records lacked guidance to ensure people received consistent and safe support. There was not an adequate process for continually assessing and monitoring the quality of the service. Staff were not always recruited safely.
When people were living with dementia, decision specific capacity assessments had not been recorded. However, people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests Staff understood how to support people to make decisions and did this on a day to day basis.
People received a reliable service from staff who knew how to provide their care in a safe way. Staff understood their responsibilities in protecting people from abuse and knew how to report any concerns they had. People were happy with the care they received and felt safe with the staff that were supporting them. People told us they were treated kindly and compassionately by the staff.
Staff communicated effectively with people and with each other to make sure people's needs were met in the way they had chosen. When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People received person-centred care that promoted their dignity and independence. Staff followed infection control policies and practices to help protect people from any infection.
People and their relatives told us the service was well managed and gave positive feedback about the service they received. They said the registered manager was approachable and sorted out any issues they had. People and their relatives spoke highly of the registered manager and staff.
Staff knew their roles and were able to tell us about the values and the vision of the service. The registered manager visited people and made calls to check people were happy with the service. Any complaints that were made were managed in the right way and people had been invited to suggest improvements to the service.
There were sufficient numbers of staff to provide the care people needed. People and their relatives said that staff arrived when they should and stayed the allotted amount of time. They reported that they had not had any missed calls. Staff received the training they needed to look after people in the way that suited them best. Staff received support, guidance and advice from the registered manager. The registered manager checked that staff were working with people safely.
People's needs were assessed and reviewed to ensure care being delivered was up to date and reflective of their needs. People had care plans that provided detailed guidance for staff on the support and care that they needed on a daily basis. People were supported to do things they wanted to do. People consented to their care and were supported by staff who were trained to fulfil their roles effectively. Staff were aware of the importance of good nutrition to people's health and well-being. Medicines were managed safety and people received their medicines as prescribed by their doctor.
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 23 December 2021) and there were breaches of regulation.
At this inspection we found the provider remained in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.
The inspection was also prompted in part due to concerns received about safeguarding incidents. A decision was made for us to inspect and examine those risks. We found the registered manager had investigated the concerns, taken appropriate action to prevent re-occurrence and lessons had been learnt. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
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.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Livingstone Care Office - Innovation House on our website at www.cqc.org.uk.
Enforcement and recommendations
We have identified breaches in relation to safe care and treatment and in relation to governance and oversight and staff recruitment. We have made a recommendation about documenting decisions relating to people’s mental capacity.
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.