Laura Care Agency was rated Requires improvement overall at its first inspection in February 2016, with particular concerns around unaudited medication records, lack of MCA and dementia training, absent competency assessments, and quality monitoring systems that failed to identify these gaps. Caring and Responsive domains were rated Good, reflecting strong staff relationships, flexible scheduling, and positive feedback from people and relatives.
Concerns (9)
criticalMedication management: “The two records we viewed from two months prior to the inspection did not provide confirmation that people had always received their medicines and creams as prescribed.”
criticalSafeguarding: “we found that we had not received one notification of a safeguarding concern that had been raised and investigated.”
moderateRecord keeping: “these medication records had not been audited as had been planned. This meant that there was a risk that medicines were not been given as prescribed.”
moderateStaff training: “Staff had not received training on MCA...training had not been provided in good dementia practice...staff did not have access to information about some healthcare conditions such as diabetes.”
moderateStaff competency: “The registered manager had no systems or processes in place to ensure that following receipt of training that staff had been assessed as competent.”
moderateConsent / capacity: “where people had been identified as lacking capacity there were no assessments available that detailed what decisions the person was unable to make.”
moderateCare planning: “when there was a change in a person's care needs these were not always clearly reflected in people's care plans and we found that some people's care plans did not contain up to date information.”
moderateGovernance: “monitoring systems in place they were not robust and in some instances not been undertaken as frequently as planned.”
minorRecord keeping: “Gaps and omissions in the recruitment practice or processes had not been identified through the quality monitoring system checks.”
Strengths
· People felt safe and relatives confirmed their family members received safe care.
· Consistent staffing enabled staff to know people well and recognise changes in their condition.
· People and relatives were highly complimentary of staff's caring attitude, with comments such as 'The level of care is exemplary.'
· People could choose and change the times of their care visits, including specifying the gender of their carer.
· The service was responsive to changing needs, with weekly informal and monthly formal reviews.
Laura Care Agency Limited was rated Requires Improvement overall at its May 2017 inspection, with persistent failures in medicines recording and administration governance and ineffective quality-monitoring systems that had not been addressed since the previous inspection in February 2016. The service performed well in effective, caring and responsive domains, with kind and consistent staff, robust care planning and good complaints handling.
Concerns (6)
criticalMedication management: “There were some gaps in the recording on the medication records so we could not establish if people had received their prescribed medicine.”
criticalMedication management: “Staff were routinely administering some medication that was only prescribed to be given 'as required' (PRN)...did not have specific protocols available for staff to follow.”
moderateGovernance: “The provider did not have robust systems to audit, monitor and improve the quality of the service within a timely manner.”
moderateGovernance: “The survey feedback had been not been analysed for any trends or patterns or used to improve the service as a whole.”
moderateIncident learning: “Spot checks...had been recorded but actions and improvements resulting from them were not evident...no overall analysis of the spot checks.”
minorConsent / capacity: “In one instance a person's relatives had agreed to the care plan when they did not have the legal authority to do so.”
Strengths
· People felt safe and spoke positively about staff, describing them as caring, kind and knowledgeable about individual needs.
· Staff received induction, regular refresher training, supervision and were safely recruited with DBS checks and references.
· Risk assessments and care plans were detailed, up to date and person-centred, reflecting people's individual preferences.
· Sufficient staffing levels with consistent staff; people reported visits were on time and not rushed.
· A formal complaints procedure was in place; no complaints received in 12 months and informal concerns were recorded and resolved promptly.
Quality-Statement breakdown (13)
safe: Medicines administration and recordingRequires improvement
safe: Risk assessments and care planning for safetyGood
safe: Staffing levels and safe recruitmentGood
safe: Safeguarding knowledge and whistle-blowingGood
effective: Staff training, induction and supervisionGood
effective: Mental Capacity Act compliance and consentGood
Laura Care Agency Limited, a domiciliary care service supporting 12 people, was rated Good across all five key questions at its January 2019 inspection, having improved from Requires Improvement in Safe and Well-Led at the previous 2017 inspection. The service demonstrated effective safeguarding, consistent staffing, person-centred care, and strong governance with no areas of concern identified.
Strengths
· People reported feeling safe and praised staff competence and kindness, with continuity of care from consistent staff allocation
· Effective safeguarding procedures in place with staff able to recognise and report abuse; no missed calls reported
· Staff trained in line with Care Certificate; monthly supervision in place; training records maintained per individual
· Mental Capacity Act awareness demonstrated by staff; consent obtained before care and support provided
· People treated with dignity and respect; independence promoted; diverse needs including cultural and gender preferences accommodated
caring: Involvement in care planningGood
responsive: Person-centred care and individual preferencesGood
responsive: Complaints handlingGood
well-led: Quality monitoring and audit systemsRequires improvement
well-led: Leadership, culture and staff supportGood