Livingstone Health Care Services improved from Requires Improvement to Good across all five key questions, having resolved a previous breach of Regulation 18 around staffing and demonstrating sustained improvements in complaints handling, communication, and governance. Minor issues with weekend staff punctuality and inconsistent cover staff competency were noted but were being actively managed by the provider.
Concerns (2)
minor
Missed or late visits
: “On Sundays the carers can be a bit late, within 20 or 30 minutes. They are relying on public transport, so it can be hard.”
minorStaff competency: “When my regular carers are not visiting, the new staff often do not understand what they are supposed to do.”
Strengths
· Previous breach of Regulation 18 (Staffing) resolved; sufficient staff now employed and electronic call monitoring system generates accurate missed/late visit reports.
· Medicines managed safely with monthly audits, appropriate protocols for 'as needed' medicines, and staff competency checks.
· Safe recruitment process including DBS checks, proof of identification, references and right-to-work verification.
· Person-centred care plans regularly reviewed with involvement of people and relatives, capturing cultural, spiritual and communication needs.
· Complaints handling significantly improved since previous inspection; relatives confirmed concerns dealt with promptly and appropriately.
Quality-Statement breakdown (24)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Assessing risk, safety monitoring and managementGood
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 guidanceGood
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: 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: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
Livingstone Health Care's first inspection rated the service Requires Improvement overall, with a breach of Regulation 18 (Staffing) due to insufficient staff causing missed and late visits. While care delivery, medicines management and staff kindness were rated Good, complaints handling, communication and governance oversight required improvement.
Concerns (8)
criticalStaffing levels: “There were not enough staff to meet every person's needs.”
criticalMissed or late visits: “We had many missed calls- especially at weekends. Once [person] had no calls for a week when the carer was on holiday.”
criticalSafeguarding: “We found evidence of an instance where concerns about care were not escalated to external professionals appropriately.”
moderateComplaints handling: “People and their relatives did not always find their concerns and complaints were managed well.”
moderateCommunication with families: “They don't contact me if there is a problem with visits, but there is also a lack of communication between the carers and the office.”
moderateGovernance: “The service was not always set up to monitor the quality of care and drive improvements in service delivery.”
moderateLeadership: “People and relatives did not all know who the manager was and who they could raise concerns with.”
moderateRecord keeping: “only approximately 50% of care staff logged their calls in this way so accurate reports and trends could not be generated”
Strengths
· Safe recruitment practices including DBS checks, employment histories and references
· Medicines were well managed and people received their medicines as prescribed, with monthly MAR audits
· Effective infection prevention and control with adequate PPE and staff training
· Staff were kind, caring and respected people's dignity, privacy and independence
· Person-centred care plans tailored to individual needs and preferences
Quality-Statement breakdown (20)
safe: Staffing and recruitment; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot 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 experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced diet
Not rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated