Lovage Homecare Ltd improved from Inadequate to Requires Improvement following a follow-up inspection on 19 July 2023, exiting Special Measures, but remained in breach of Regulations 11 (MCA/consent) and 17 (good governance). Key ongoing failures include the absence of mental capacity assessments and best interest decisions for a known at-risk individual, and ineffective or absent governance audits across multiple areas of care delivery.
Concerns (5)
criticalConsent / capacity: “There were no individual capacity assessments or best interest decisions in place for this person. This placed this person at risk of not receiving care and treatment they had consented to or in their best interest.”
critical
Governance
: “Quality checks and audits were inconsistently completed in the service. There were no audits in place to identify that people's care was not being delivered in line with MCA.”
moderateMedication management: “Staff were not currently signing the MAR, they were putting an 'x' to show administration. The medicines audit had not identified where staff were not signing the MAR.”
moderateStaff competency: “Although staff had received training since the last inspection, there was a lack of understanding around the Act and from the registered manager and provider around their responsibilities.”
minorRecord keeping: “Risk assessments and care plans were now in place when needed... Some of these lacked detail however the registered manager was aware of this and working to improve these.”
Strengths
· Sufficient staff available to support people; relatives and people confirmed consistent carer allocation.
· All staff received mandatory and role-relevant training including diabetes, and a structured documented induction was introduced.
· Medicine administration records (MAR) now in place and staff received medicines training and competency checks.
· Safe recruitment processes established with DBS checks completed for all staff.
· Safeguarding training delivered; staff able to recognise abuse and knew reporting routes.
Quality-Statement breakdown (14)
safe: Medicines management; Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Requires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Managers and staff being clear about their roles; quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive person-centred, open, inclusive and empowering cultureGood
well-led: How the provider understands and acts on the duty of candourGood
Lovage Homecare Ltd was rated Inadequate overall at its first inspection in November 2022, with widespread breaches across safe care, staffing, consent, and governance. The service was placed in special measures due to critical failures in medicines management, unsafe recruitment, absent MCA compliance, and a part-time registered manager leaving the nominated individual without adequate oversight.
Concerns (13)
criticalMedication management: “Systems had not been established to ensure the safe administration and management of medicines. Staff had not received training to ensure they were safe to support people with medicines.”
criticalSafeguarding: “They had failed to notify CQC of the concerns as required by law. The nominated individual advised they were not aware of their duty to notify us of safeguarding incidents.”
criticalStaff training: “There was no record of staff having received an induction and the provider relied on the skills and knowledge staff had acquired in other employment.”
criticalStaff competency: “There was no record of competency assessments ever being carried out. This placed people at risk of harm.”
criticalGovernance: “The provider had failed to establish systems to assess, monitor and improve the quality and safety of the service provided. This placed people at risk of harm.”
criticalConsent / capacity: “The nominated individual was not aware of their responsibilities in relation to the MCA...placed people at risk of being deprived of their liberty without authorisation.”
criticalCare planning: “Care plans failed to identified people's individual preferences and were generic in nature. People's needs had not been fully assessed.”
criticalLeadership: “The registered manager had only been available to work at the service for approximately 2 weeks of each month...lack of oversight and governance systems were detrimental to the care people received.”
moderateRecord keeping: “Staff had not been trained sufficiently in the recording of people's care and support. We found daily notes were extremely limited and contained little information.”
moderatePerson-centred care: “The provider failed to carry out full assessments of need for people and failed to review people's care to ensure it still met their needs.”
moderateEnd-of-life care: “Guidance about how they should be specifically supported in relation to their end of life wishes had not been considered.”
moderateCommunication with families: “Only one person was aware of who the nominated individual was. No-one who spoke with us knew the registered manager.”
minorCultural competency: “There was a lack of information available for staff about people's individual needs in relation to race, religion or sexual orientation.”
Strengths
· People received support from staff at the time they needed it and were notified of any delays in support calls.
· Staff used PPE in accordance with the provider's infection control policy.
· Where incidents or events had occurred, the nominated individual had taken action to make improvements.
· The nominated individual had responded appropriately to complaints and carried out investigations.
· Staff felt supported by the nominated individual and felt their feedback was considered and taken seriously.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement