Lucien and Marcel Home Care Ltd improved from Requires Improvement to Good across all three inspected key questions (Safe, Responsive, Well-Led), having remediated all prior regulatory breaches relating to risk management, medicines, recruitment, care planning, and governance. One minor medicines recording issue was noted but did not constitute a breach.
Concerns (1)
minorMedication management: “staff had failed to record administration using their initials and had ticked to demonstrate medicines had been taken by people”
Strengths
· Provider addressed all previous breaches of Regulation 12, 19, 9, and 17 since last inspection
· Risk assessments and care plans personalised to individual needs with staff guidance on managing identified risks
· Safe recruitment procedures now in place including references, employment gap checks, DBS and right-to-work verification
· Staff matched to people who share their first language to ensure inclusive, accessible communication
· Registered manager conducts spot checks of care and medicines administration records
First inspection of this newly registered domiciliary care agency found four breaches of regulation covering person-centred care, safe care and treatment, good governance and fit and proper persons employed, with risks not assessed, unsafe medicines management and inadequate recruitment checks. Staff were caring, suitably trained and supported, and people and relatives reported reliable, kind and respectful support, but the service was rated Requires Improvement overall.
Concerns (15)
criticalMedication management: “The management and administration of medicines was unsafe. The provider's medicine procedure was not in line with current legislation and guidance.”
criticalCare planning: “People's care plans were not personalised to their needs One person's care plan did not have information relating to their medical health need.”
criticalCare planning: “There was no care plan or guidance in place covering the process to follow on how to manage this effectively (PEG tube)”
criticalStaff competency: “The registered manager had not assessed staff competency to ensure they could perform this task safely.”
criticalOther: “Three staff files checked did not contain references in line with legislation and best practice guidance. The registered manager confirmed they did not check references”
criticalGovernance: “The provider and registered manager had failed to operate systems to assess, monitor and improve the quality of the service provided.”
criticalLeadership: “The registered manager lacked oversight of the service delivered, thereby putting people at risk of unsafe care.”
criticalOther: “Risks to people were not effectively managed putting them at risk of harm... the risk associated with this condition had not been assessed and there was no guidance for staff”
criticalPerson-centred care: “Care was not planned and tailored to people's individual needs”
moderateMedication management: “Staff did not complete medicine administration records (MAR) correctly. One person's MARs only had a tick against the medicine administered instead of a staff signature”
moderateStaff competency: “Records showed staff had attended medicine administration training. However, the registered manager had not checked or assessed their competency.”
moderateOther: “Employment histories were not always checked to ascertain the reason for gaps within individual's employment history.”
moderateGovernance: “The quality of documentation and policies for managing the service did not meet current legislation and guidance.”
moderateCommunication with families: “communication with staff and people may not always be effective as staff had been carrying out some care and support tasks which the registered manager had told us they were not doing.”
minorComplaints handling: “The complaint procedure did not provide information on the stages of the complaint procedure and contacts of independent reviewing authorities”
Strengths
· Staff trained in safeguarding adults and knew how to report and escalate concerns
· Sufficient staffing levels with reliable, punctual carers reported by people and relatives
· Effective infection control practices with PPE provided and used
· Staff received induction, regular training, supervision and spot checks
· Staff and registered manager understood MCA principles and obtained consent before delivering care
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience