Date of on-site assessment 05 February 2024. Luv to Care Home Care Ltd is a domiciliary care agency providing personal care to people in their own homes. The service provides support to younger and older people with a variety of needs, including people living with dementia. At the time of our assessment there were 52 people using the service. This assessment was prompted by information we held about this service. We assessed a total of 10 quality statements under the Safe, Effective, and Well-led key questions. At the last inspection this service was rated as requires improvement. During this assessment we evidenced that the provider had made and embedded a number of improvements across the service and overall the service was performing well under the quality statements we reviewed. There were enough staff to meet people’s needs, however feedback from some people indicated that newer staff were not always confident or lacked experience which they felt impacted their experience of the care provided. We found there were sufficient control measures to mitigate identified risks to people. The provider operated safe and effective safeguarding systems. Overall, the systems to manage people’s medicines were suitable and mostly reflected best practice guidance. Staff wore appropriate personal protective equipment and understood the importance of protecting people from the risk of infection. People were supported by staff who understood the importance of enabling people to make decisions. People’s needs were assessed before they received a service, and this information was used to generate person-centred support plans on how staff should support people to meet their needs. The provider operated effective quality assurance and governance systems to ensure they maintained oversight of the running of the service. Staff told us they felt the service was well-led and most staff felt supported in their role.
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Luv To Care Home Care Ltd's first CQC inspection rated the service Requires Improvement overall, with Safe, Effective and Well-led all falling short due to medicines record-keeping gaps, incomplete Mental Capacity Act compliance, inconsistent infection control practices and ineffective governance audits. Caring and Responsive were rated Good, reflecting strong person-centred practice, dignified care and responsive complaint handling.
Concerns (10)
criticalConsent / capacity: “a relative had provided consent on the persons behalf without the appropriate legal authorisation to do so.”
moderateMedication management: “records did not include the dose amount that had been given and administration charts were not in line with the prescription.”
moderateMedication management: “administration records did not include all required information for staff to follow on how and when this medicine may be required.”
moderateGovernance: “Medicines audits did not identify our findings in relation to PRN protocols, consistency in electronic records for variable dose medicines or application information.”
moderateCare planning: “where a person had recently been prescribed a modified diet, their care plan had not been appropriately updated to robustly detail their current needs.”
moderateStaff training: “some staff had not completed up to date training in medicines administration and moving and handling practical sessions to ensure they were competent in their role.”
moderateGovernance: “audits of people's care records failed to identify our findings where there were inconsistencies in completion of the provider's assessment tools.”
minorInfection control: “policies and risk assessment information specifically in relation to COVID-19 did not reflect current best practice guidance.”
minorCommunication with families: “people and their relatives were not always aware which staff would be attending the call. 'No we don't ever know who is coming and when, it's all very ad hoc'”
minorRecord keeping: “one person's recruitment file did not demonstrate their full employment history and...satisfactory evidence of their conduct in those roles had not been sought.”
Strengths
· People and relatives reported feeling safe and expressed high satisfaction with the kindness, compassion and dignity shown by care staff.
· Care plans were personalised, including people's histories, routines and preferences, and were accessible to staff via an electronic system.
· Robust incident reporting system in place with registered manager maintaining oversight to identify themes and patterns.
· Clear safeguarding systems and processes in place; staff knew how to raise concerns and appropriate referrals were made.
· Positive staff culture fostered by provider, with staff feeling appreciated, supported and able to raise concerns openly.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Learning lessons when things go wrongGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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: Staff working with other agencies to provide consistent, effective, timely careGood
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 supportGood
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: Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood