Homecarers Liverpool Limited received a Good rating across all five key questions at its September 2017 inspection, demonstrating full remediation of previous breaches related to person-centred care and quality assurance governance. The service of 557 people supported by 232 staff was found to be well-led, with robust electronic monitoring systems, strong staff training and support structures, and effective partnership working across the local health and social care sector.
Strengths
· Robust quality assurance systems including audits, spot checks, home visits, and quality questionnaires with action plans derived from feedback.
· Electronic PASS system and ICareHealth GPS call monitoring enabled real-time tracking of visits and up-to-date care information for staff.
· Safe and thorough recruitment processes including DBS checks and two written references for all staff.
· Staff well-supported through structured induction, Care Certificate, shadowing, regular supervision, annual appraisal, and ongoing training including dementia and MCA.
· Medication managed safely by trained staff using the PASS electronic MAR system with office alerts for unrecorded administrations.
Homecarers Liverpool Limited was rated Requires Improvement overall following an announced inspection in October 2016, with breaches of Regulation 9 (person-centred care) and Regulation 17 (good governance) identified. Care records lacked personalisation and depth, medication administration records were inconsistently signed, and audit systems failed to identify key quality issues, though staff were found to be kind, well-trained, and safeguarding practices were sound.
Concerns (6)
criticalCare planning: “care records were not person-centred. The information contained within these was task-led and did not contain information on people's strengths, personal histories, likes, dislikes or preferred daily routines.”
criticalGovernance: “medication audits had failed to identify where staff had not been signing the MARs appropriately...Audits of people's care records had failed to identify a lack of sufficient information.”
criticalPerson-centred care: “non-regular staff were not always aware that their relative was living with dementia...staff trying to prompt their relative to take their own medication, putting all the tablets in their hand.”
moderateMedication management: “seven of these had not been consistently signed or completed by staff. In one example staff had used a code ('o') to indicate that 'other' action had been taken, however it was not documented what this action was.”
moderateRecord keeping: “one person's care record stated that they had schizophrenia and were alcohol dependent but there was no additional information to show what impact these factors had upon the person.”
moderateIncident learning: “An audit of accidents and incidents for people using the service had not been completed. This meant that the registered provider may not be able to pick up on trends.”
Strengths
· Staff had received training in safeguarding and were aware of how and when to report concerns, with a whistleblowing policy in place.
· Sufficient numbers of staff were in place and recruitment processes were robust, including DBS checks and two references.
· Staff completed induction aligned to the Care Certificate and received refresher training and nationally recognised qualifications.
· Staff received regular supervision and appraisals allowing discussion of training needs and performance.
· People spoke highly of staff kindness, dignity, and compassion, with staff going above and beyond their normal role.
Homecarers Liverpool Limited received a Good rating overall following a focused inspection of Safe and Well-Led domains, with 521 people supported across Liverpool, Knowsley and Wirral. The main concern was difficulty contacting the office to report late or missed calls due to COVID-19 business continuity arrangements, though no one was found to be at risk.
Concerns (2)
moderateCommunication with families: “some people were unhappy at not being able to get through to the office to amend their service or report a late or missed call”
moderateMissed or late visits: “people were left waiting for their call, uncertain if the carer was due to arrive”
Strengths
· Effective safeguarding systems in place with staff understanding their responsibilities
· Staff recruited safely with sufficient numbers to support people's needs
· Medicines administered at the right time with regular competency assessments of staff
· Infection control updated for COVID-19 with PPE consistently worn by staff
· Regular quality audits completed including medication records, accident/incident reports and call monitoring
effective: Nutrition and hydration support
Good
caring: Staff kindness and dignityGood
caring: Involvement in care planningGood
responsive: Person-centred care recordsRequires improvement
responsive: Complaints handlingGood
responsive: Care reviewsGood
well-led: Audit and quality monitoring systemsRequires improvement