Luton Friendship Home Carers Limited

Luton Friendship Home Carers Limited is a domiciliary (home care) care agency. It provides personal care to people living in their own houses and flats.

At the time of our inspection there were 41 people using the service. 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.

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

Staff were trained and knowledgeable about safeguarding processes including identifying and reporting any risks to people's safety. Risks to people and staff were identified and managed.

There were enough safely recruited staff and they had appropriate skills to safely meet people's needs. There were effective systems in place which supported good infection prevention and control practise. One person said us, “I get the same consistent staff and they arrive spot on time. They always let me know if they may be slightly late."

Due to restrictions imposed as a result of the pandemic, the registered manager used video technology to train staff in practical ways such as how to support people with moving and handling. Staff had training and had various means of support such as, mentoring to help develop their skills.

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; the policies and systems in the service supported this practice. One relative told us how skilled staff were encouraging their family member to eat. Lessons' were learned when things went wrong, and learning was shared across the staff team.

People were supported eat and drink enough and have access healthcare services. The provider and its staff worked well with others involved in people's care.

Staff supported people to live a meaningful live and received care that was based on their preferences. Staff were creative in their approach to treating people equally well, whatever people's communication skills. People's concerns were acted on before they became a complaint. There were policies and procedures to support people with end of life care if needed.

The service had a registered manager, but they had been off since March 2020. A new manager was in post and they were applying to be the registered manager. They supported staff and had developed an open and honest staff team culture. Audits, oversight and governance were effective in driving improvements. People, relatives, and staff had a say in how the service was run. The provider worked well with others to help ensure people received joined up care.

Rating at last inspection

The last rating for this service was requires improvement (published 14 June 2019).

We carried out an announced comprehensive inspection of this service between the 20 and 23 May 2019 and three breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staff recruitment and the effectiveness of the provider's quality assurance.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions: Is the service Safe, Effective, Responsive and Well-led questions, which contain those requirements.

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 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 Luton Friendship Home Carers Limited on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People were not always kept safe from harm. Risk assessments in areas such as mobility, eating and drinking and specific health conditions were either not completed or lacking sufficient detail.

People’s personalised support needs such as dementia, diabetes and mental health were not identified in people’s care plans. There was limited information in care plans to instruct staff how to support people with these needs.

Staff received training and supervision, however these were not frequent and in line with the provider’s policy. Training in key areas had expired for some staff members. This had not been actioned by the registered manager.

Audits and systems in place to monitor the quality of the service were not effective in identifying shortfalls or areas where the service could improve. Some information was out of date. The registered manager and office staff were moving records on to an electronic system which meant that some documents and records were hard to find and to monitor.

People and their relatives were positive about the care they received. One person said, ‘‘I think the service is excellent. For what [Staff] do and how hard they work, they have the patience of saints.’’

People were supported with kindness, respect and compassion by a consistent staff team who knew them well.

Robust and thorough recruitment checks were in place before staff started working at the service. People received their care visits on time and knew the staff supporting them.

People were supported safely with their medicines.

People had access to healthcare professionals and staff supported people to health appointments when these were needed.

People were supported in line with the Mental Capacity Act however it was not always clear how people’s capacity had been assessed. We have made a recommendation to the service to seek further guidance and training around the Mental Capacity Act.

People’s wishes at the end of their life were not always recorded. We have made a recommendation to the service to find out if people wish to put plans in place for this time of their lives.

The registered manager and staff team were passionate about person centred care. People, their relatives and the staff team were positive about the management of the service.

Rating at last inspection: At the last inspection the service was rated Good (report published 21/04/2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. During this inspection we found evidence which means that the service is now rated as Requires Improvement. Full details are in the report below.

Enforcement: We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

There was a registered manager in post. 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 were kept safe from any risk of harm and staff knew how to report any concerns regarding people’s welfare. Risk assessments were carried out on both the environment and on behalf of the person to detail ways in which they could be kept safe. There were enough trained and competent staff available to meet people’s needs, and people told us they usually received their calls on time. There were robust recruitment procedures in place to ensure that staff employed were suitable to work in the service. People received their medicines as prescribed by staff who were trained and competent.

Staff received a variety of training that was regularly updated and refreshed as required. Supervisions and performance reviews took place with the management team to provide them with an opportunity to develop their skills further. Training was provided to understand the Mental Capacity Act 2005 and assessments were carried out where people required decisions to be made on their behalf. People consented to their care and support. People’s healthcare needs were met by the service and they were referred to other healthcare agencies for support where required. People who required support with cooking, eating and drinking had their dietary needs met.

Staff were caring and understood the people they were providing care to. People were treated with dignity and respect and given opportunities to give their feedback on the quality of their care.

People’s care plans were detailed and comprehensive enough to provide an overview of the person’s needs and preferences. If people’s needs changed then the service were responsive to this and worked closely with other stakeholders to ensure consistency of care. Regular reviews took place with the person and their relatives to give them an opportunity to contribute to the planning of their care. The service had a robust policy in place to handle complaints and dealt promptly with those received.

People, relatives and staff were positive about the management of the service. The visions and values of the provider were clear and people spoke highly of the ethos of the organisation and how it translated into practice. Staff were given opportunities to develop and contribute to the service through team meetings. There was a robust system in place for quality monitoring and identifying improvements that could be made in all areas of the service.

We found that people's needs had been assessed to ensure the care they received was safe and effective.

The agency had procedures in place to ensure that people were safeguarded against the risk of abuse and staff had been provided with appropriate training. One person said, 'Staff saw bruising on my arms and asked how it had happened. They are always mindful of unexplained marks or injuries.' This demonstrated that staff acted appropriately if they suspected people were at risk of harm.

We found that the agency had effective recruitment procedures to ensure appropriate checks were undertaken before staff commenced work.

We found that although there was a system in place to provide staff with supervision and appraisal this was not consistently delivered to all staff in line with the organisation's procedure.

The agency had a system in place to assess and monitor the care provided to people. This ensured people were listened to, acted on and addressed in a timely manner.

Care plans were detailed and contained good guidance for staff. Two relatives we spoke with said that the staff understood their relative's needs, and knew how to care for them. One relative said ,' The staff know my relative's likes and dislikes. They have built up a good relationship with her.'

All of the people we spoke with said that the care staff generally arrived within 15 minutes of the expected time and had never missed a visit. People felt their views were listened to and felt confident to make a complaint if they needed to.