This inspection took place on 20 March 2017 and was announced. Lalis Direct Care Limited is a domiciliary care agency that provides personal care for people in their own homes. At the time of our inspection, the agency provided approximately 900 hours of support on a weekly basis to 81 people. These included people with learning and physical disabilities, sensory impairments, older people and people who lived with dementia.
There was a registered manager in post at the time of our inspection. 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.
The registered manager was supported by the provider, the branch manager, two senior care coordinators, two payroll officers and 22 care workers.
The service was last inspected on 03 February 2016. At that time, we found the agency was not meeting all the required Regulations. We observed that people were not always safe as the agency did not have detailed plans in place for management of identified risks to people’s health and wellbeing. Additionally, the agency’s quality audits were not effective in highlighting concerns and mitigating risks to people.
At the inspection on 20 March 2017, we found some improvements had been made and further improvements were needed in other areas.
The agency did not always ensure that people were safe from harm and abuse. People and their relatives gave us mixed feedback about care they received from care workers who supported them.
Care workers received safeguarding training, however, not all of them had a good understanding of the principles of safeguarding vulnerable adults.
The agency did not always manage medicines administration safely and there was a risk that people would not receive their medicines as prescribed.
The agency did not always work within the principles of the Mental Capacity Act 2005 (MCA) and there was a risk that decisions related to people’s everyday care were not made in their best interest or with their consent.
The agency did not always involve people in planning of their care and did not always take into consideration people’s personal wishes and preferences.
People told us they were not always satisfied with how the agency dealt with their complaints.
The agency had systems in place to asses and monitor the quality of the service however they were not always effective.
The agency did not follow their legal duty to submit statutory notifications and did not display their most recent performance rating on their website as required by the Regulations.
Care workers had guidelines on how to manage risk to people’s health and wellbeing, however, some care documents had inconsistent information on what these risks were.
The agency had a process in place for reporting of incidents and accidents and care workers followed it.
The agency had robust recruitment procedures in place to ensure only suitable care workers were appointed to work with people who used the service.
The agency had a rota system in place to ensure that all calls were covered and care workers knew who they were assigned to visit that week.
The agency worked closely with the local authority and other health care professionals to make sure people were supported to maintain good health and have access to healthcare services.
New care workers undertook an induction that consisted of the training the provider considered mandatory and shadowing of more experienced colleagues.
Care workers received regular training, supervision and appraisal of their work.
People’s care plans consisted of clear and practical instructions on how to support people they cared for.
People we spoke with told us care workers respected their dignity and privacy when providing personal care.
The agency sought regular feedback from people and their relatives about the service provided.
Care workers told us they felt supported by the registered manager and the office staff and that there was a fair and open culture of communication within the agency.
External stakeholders had mixed feedback about their experience of the quality of the service provided by the agency.
We have made two recommendations relating to the review of risk assessment documents and gathering information about nutritional needs of people who used the service.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.