Livingstone Health Care Limited

Livingstone Healthcare Limited is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to people in their own homes. 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.

The service was supporting 13 people with personal care at the time of the inspection.

People’s experience of using this service

Risks assessments were not always robust to ensure people received safe care. Medicines were not always being managed safely. Robust systems were not in place to ensure staff attended calls on time. Pre-assessments systems were not robust in capturing people’s preferences and risks. Care plans did not always include people’s preferences with personal care to ensure they received person centred care. We made a recommendation in this area.

Robust audit arrangements were not in place to ensure shortfalls could be identified and prompt action taken.

Incidents were recorded to ensure lessons were learnt. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were aware of how to safeguard people from abuse. Systems were in place to prevent and minimise the spread of infections when supporting people. Pre-employment checks had been carried out to ensure staff were suitable to work with people. Systems were in place to ensure feedback was received from people on their care.

Staff had been trained to perform their roles effectively. Staff supervisions were regular to ensure staff were being supported at all times.

People received care from staff who were caring and had a good relationship with them. Staff respected people’s privacy and dignity. People were encouraged to be independent and to carry out tasks without support.

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 the service was Good, published on 13 July 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service is now Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Livingstone Healthcare Limited on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to need for safe care and treatment, staff timekeeping and good governance at this inspection.

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.

This service is a domiciliary care agency based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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.

The service was supporting 15 people with personal care at the time of the inspection.

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

Risk assessments had been carried out to ensure people received safe care. Pre-employment checks such as references had been sought to ensure staff were suitable to support people. Systems were in place to monitor staff time-keeping and prevent infections.

People and relatives told us that staff were caring and they had a good relationship with staff. People had been involved in decisions about their care.

Quality assurance systems were in place to identify shortfalls and take prompt action to ensure people always received safe care. Feedback was sought from people and relatives to make improvements to the service.

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 previous rating for this service was Requires Improvement (published 1 January 2021).

Why we inspected

We undertook a focused inspection to review the key questions of Safe, Caring and Well-Led to check if improvements had been made since our last comprehensive inspection.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions 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 inspection, by selecting the ‘all reports’ link for Livingstone Health Care 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.

This service is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to 41 people.

People’s experience of using this service

At our last comprehensive inspection on 23 September 2019, we found a number of shortfalls. We found that supervisions were not being carried out regularly to ensure staff were being supported, training in mandatory areas was not being delivered and consent had not been sought from people on the care they received. We also found care plans were not person centred and pre-assessments were not robust to determine if the service could support people effectively. During this inspection, we found improvements were made.

Regular supervisions had been carried out to ensure staff were supported to carry out their roles.

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.

Robust pre-assessments systems were in place to determine if people could be supported effectively. Care plans were person centred and included how to provide personalised support to people. Quality assurance systems were in place to identify shortfalls and take prompt action to ensure people always received safe care.

Complaints had been managed in a timely manner. Systems were in place to obtain feedback from people and relatives.

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

Rating at last inspection

The previous rating for this service was inadequate (published 16 November 2019) and there were multiple breaches of regulation. CQC had issued Warning Notices for Regulation 17 (Good Governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a requirement notices issued for Regulation 9 (person centred care), Regulation 11 (need for consent) and Regulation 18 (staffing) of the same Act.

We carried out a targeted inspection on 25 March 2020 (published 10 April 2020) to check if the service was compliant with the warning notices we served for Regulation 17 (Good Governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities). We found the service was compliant with the warning notices.

Why we inspected

We undertook a focused inspection to review the key questions of effective, responsive and well-led to check if the service was compliant with the requirement notices issued at the last comprehensive inspection and if improvements had been made.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

This service has been in Special Measures since 16 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall. Therefore, this service is no longer in Special Measures.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Livingstone Health Care 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.

This service is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to 55 people.

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

At our previous inspection of this service on 23 September 2019, we found risk assessments were not robust and did not identify risks to people around their health conditions and medicines were not being managed safely. At this inspection, we found improvements had been made and people’s risks were assessed and control measures were in place to mitigate risks. We also found improvements with medicine management.

At the previous inspection, we found effective quality assurance systems were not in place to identify the shortfalls we found during the inspection. The shortfalls we found were in oversight of training and supervisions, care plans were not person centred, lack of effective risk assessments and medicines not being managed safely.

The service had completed an action plan in response to CQC enforcement since our last inspection and had complied with this action plan through robust quality assurance systems. The management team had completed spot checks on people using the service. There were systems in place to ensure ongoing spot checks would be completed regularly.

The provider had introduced a number of audits such as on medicine management and care plans. A training matrix was in place. This meant the provider had improved oversight of training and ensured future training had been booked for staff to ensure their compliance with training outcomes. Staff received supervision and the provider had systems in place to ensure staff received supervisions regularly. Audits carried out on care plans, risk assessments and medicine management resulted in people receiving safe and responsive care.

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

Rating at last inspection

The previous rating for this service was inadequate (published 16 November 2019) and there were multiple breaches of regulation. CQC had issued Warning Notices for Regulation 17 (Good Governance) and Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were also requirement notices issued for Regulation 9 (person centred care), Regulation 11 (need for consent) and Regulation 18 (staffing) of the same Act. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had been made and the service was compliant with the warning notices issued.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

This service is a domiciliary care agency and is based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes. 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, the service provided personal care to 38 people.

People’s experience of using this service

Medicines were not being managed safely as the provider was not aware staff were administering medicines to people. Sufficient risk assessments were not in place to ensure people received safe care at all times. Some staff had not received training to ensure they could perform their roles effectively. Regular supervisions had not been carried out to ensure staff were supported to carry out their roles.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Robust pre-assessments systems were not in place to ensure people received support in a person-centred way. Care plans were brief and were not person centred. Quality assurance systems were not in place to identify shortfalls and take prompt action to ensure people always received safe care. Adequate safeguarding systems were not in place to ensure people were protected from abuse. We have made a recommendation in this area.

There was no system in place to evidence that people had been involved in the decisions about the support they received. People’s beliefs and religions had not always been captured in care plans.

People and relatives told us that people were safe when supported by staff. Pre-employment checks had been carried out to ensure staff were suitable to support people. People and relatives told us staff were punctual and systems were in place to monitor time keeping. Systems were in place for infection control and to learn from lessons following incidents.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

Complaints had been managed in a timely manner. Systems were in place to obtain feedback from people and relatives.

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 21 August 2017 and this was the first inspection.

Why we inspected

This was a planned inspection based on when the service started to provide the regulated activity of personal care. The service registered with the CQC on 21 August 2017 and started to provide the regulated activity of personal care on December 2018.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Enforcement

We have identified breaches in relation to risk assessments, medicine management, training and supervision, need for consent, person centred care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.