LIM Independent Living and Community Care Services Limited is a domiciliary care agency providing personal care to people living in their own homes. At the time of our assessment there were 6 people using the service. This assessment took place between 26 Jul to 14 Aug 2024. We undertook this assessment to review progress made since our last assessment and to follow up on previous breaches of regulation. This was a comprehensive assessment and we assessed all 34 quality statements across the 5 key questions. The service had made improvements and were no longer in breach of regulations. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. Right support: People were protected from risk of abuse. Risk to people was managed well. People received timely care calls from trained staff. Only suitable staff worked at the service. Staff reduced infection risks to people. The service worked with partners to help people achieve positive outcomes. People were provided information which met their needs. The service was now working within the principles of the Mental Capacity Act. Right care: People received care tailored to them and their needs. People had choice and control and staff respected their decisions. People’s care was reviewed to ensure this was effective. People were treated equally and fairly and supported to access care and support that met their needs. People’s rights were understood and respected. Right culture: Staff understood their role to provide safe, quality care. Governance systems enabled effective oversight of the safety and quality of care. Staff were valued and treated fairly. People and staff could raise concerns because the service promoted a culture of openness, honesty and improvement.
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LIM Independent Living & Community Care Services Limited was rated Inadequate overall following a March 2023 inspection, with six Warning Notices issued covering person-centred care, safe care and treatment, safeguarding, governance, recruitment, and staffing. Critical failures included an unregistered child receiving care without appropriate DBS checks, widespread absence of risk assessments and medicines protocols, a registered manager with insufficient knowledge of audit, safeguarding and regulatory requirements, and a pattern of late care visits with no improvement strategy.
Concerns (14)
criticalStaffing levels: “The provider's care call monitoring data showed a high number of calls where staff were late to arrive... there was not a sufficient number of staff to safely cover all the care calls.”
criticalSafeguarding: “The provider had not identified this issue and only became aware of it when we raised it with them. This had put the child at risk of potential abuse.”
criticalMedication management: “The provider did not use a Medicines Administration Record (MAR) chart when staff applied creams to people's skin... put the person at potential risk of harm.”
criticalCare planning: “People's care, treatment and support plans did not reflect their range of needs... no specific risk assessments in place for people.”
criticalGovernance: “The provider had not carried out any audits of the service other than accident and incident audits... The provider had not identified any of the issues we found during our inspection.”
criticalLeadership: “The registered manager did not know how many people the service was supporting. They told us the service was providing care to 25 people. However... at least 52 people received care.”
criticalStaff training: “Staff had not received training in learning disability and autism... Some staff told us they had not done any safeguarding refresher training.”
moderateRecord keeping: “The provider did not have evidence of the legal authorisation giving families the power to make decisions about their relatives' care.”
moderatePerson-centred care: “People's needs assessments and care plans did not contain sufficient personalised or person-centred information... mainly about what tasks staff needed to carry out.”
moderateCommunication with families: “People frequently received late care calls and the provider did not always contact people to let them know their care call would be late.”
moderateMissed or late visits: “One service user told us their care call was due at 08:00 and they often had to wait until after 10:00 before the care worker arrived.”
moderateStaff competency: “Not all staff understood how to protect people from poor care and abuse and the provider lacked knowledge of how to work with other agencies to do so.”
moderateConsent / capacity: “The provider did not have evidence of the legal authorisation giving families the power to make decisions about their relatives' care.”
moderateIncident learning: “The provider told us they mainly dealt with issues in isolation, on an individual basis. This meant there was no systematic way for the provider to monitor the service.”
Strengths
· Staff were kind, compassionate and caring; people reported feeling well-treated with dignity and respect.
· Very low staff turnover provided people with continuity of care from workers who knew them well.
· Infection prevention and control practices were adequate; PPE was used effectively and safely.
· Accident and incident audits included analysis and learning was shared with staff.
· Staff worked effectively with GPs, district nurses, hospital staff and local authorities to support people's health needs.
Quality-Statement breakdown (26)
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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 careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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: Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood