Livingstone Care Office - Innovation House was rated Requires Improvement overall at its October 2023 inspection, with confirmed breaches of Regulations 12, 17 and 19 relating to unsafe risk management, poor governance and record-keeping, and unsafe staff recruitment. Despite these failings, people experienced compassionate, person-centred care from consistent staff, with effective partnership working and medicines management noted as particular strengths.
Concerns (8)
criticalCare planning: “Care records lacked guidance to ensure people received consistent and safe support. Risk assessments had not been fully completed for all potential risks to people's health and welfare.”
criticalGovernance: “Checks and audits were not consistently robust. Some of the shortfalls found during the inspection had not been identified by the registered manager and management team.”
criticalRecord keeping: “Some records were disorganised and could not be accessed easily. The provider had failed to maintain accurate, complete and contemporaneous record in respect of each service user.”
criticalStaffing levels: “Full employment histories had not been obtained in the three staff files we reviewed. Gaps in employment had not been explored or explained.”
moderateConsent / capacity: “Some people were living with dementia and may not have capacity to make decisions. There had been no decision specific capacity assessments recorded.”
moderateIncident learning: “On a couple of occasions, the registered manager had failed to notify CQC of events that had happened at the service.”
moderateSafeguarding: “When incidents had occurred, the registered manager had informed the local authority safeguarding team. However, they had not all been reported to CQC.”
minorEnd-of-life care: “People were asked about their wishes at the end of their lives, but this had not been fully recorded in their care plans.”
Strengths
· People received kind and compassionate care; relatives praised staff as 'caring and compassionate' and noted care was 'beyond excellent'.
· Medicines were managed safely; staff received training and competency assessments, and regular medicine audits were completed.
· Infection prevention and control practices were followed; staff used PPE appropriately and received IPC training.
· People received a reliable, consistent service from a regular team of staff with no reported missed calls.
· The registered manager built positive relationships with external healthcare professionals including GPs, palliative care nurses and hospice teams.
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
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 lawGood
effective: Staff support: induction, training, skills and experienceGood
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: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
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 preferencesGood
responsive: Meeting people's communication needsGood
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 requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candour; Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood