Lincolnshire Quality Care, a domiciliary care agency serving 340 people in Grimsby, was rated Requires Improvement overall following inspections in May 2016, with breaches of Regulations 12 and 17 relating to unsafe medicines management and ineffective quality monitoring systems. Strengths included caring and consistent staff, robust recruitment, and comprehensive training, but significant gaps in care planning, risk assessment, record-keeping, and governance oversight undermined safe and effective service delivery.
Concerns (11)
criticalMedication management: “Not ensuring people received their medicines as prescribed was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalMedication management: “staff were not always recording this consistently on the MARs, increasing the risk of medicines errors... there continued to be some medicine errors, including a more serious one in recent weeks”
criticalRecord keeping: “People were not always protected from unsafe care because risks to their safety and wellbeing were not always identified and accurate and up-to-date records were not maintained.”
criticalGovernance: “The registered provider did not have effective quality monitoring arrangements in place. This was a breach of Regulation 17 of the Health and Social Care Act 2008.”
moderateCare planning: “some care plans contained minimal directions for staff to provide support in areas such as personal care, catheter care, meals and mobility whereas other care plans were much more detailed.”
moderateCare planning: “where people's care records identified staff were providing care to prevent pressure damage, there was no assessment completed to identify the level of risk”
moderateGovernance: “systems were not in place to review key data including spot checks, supervision and training, complaints, incidents and accidents to identify any learning”
moderateIncident learning: “Information from incidents and complaints was not reviewed to identify any trends or themes.”
moderateSupervision / appraisal: “Records showed all the care co-ordinators and approximately 30% of the care workers had received supervision in recent weeks.”
minorConsent / capacity: “people's capacity to make decisions was not considered and recorded within the assessment and care planning process which the registered manager confirmed they would address.”
minorMissed or late visits: “Records showed there were some incidents of missed calls... one person told us their additional care worker had not turned up that morning and they had not been given any explanation”
Strengths
· Staff were trained and knowledgeable about safeguarding people from harm and abuse, with confidence to identify and escalate concerns.
· People spoke highly of caring, kind and respectful staff who knew their individual needs, preferences and personal histories.
· Effective recruitment policies and procedures were in place including DBS checks, written references and thorough application assessment.
· Staff received a broad range of training including a four-day structured induction followed by shadowing an experienced care worker.
· The service demonstrated flexibility and responsiveness to people's changing needs and preferences, with a robust complaints procedure.
Quality-Statement breakdown (16)
safe: Medicines managementRequires improvement
safe: SafeguardingGood
safe: Staffing and recruitmentGood
effective: Mental Capacity Act and consentRequires improvement
effective: Staff trainingGood
effective: Supervision and appraisalRequires improvement
effective: Nutrition and health needsGood
caring: Kindness and relationshipsGood
caring: Involvement in decisions and choiceGood
caring: Privacy and dignityGood
responsive: Care planning and risk assessmentRequires improvement
responsive: Complaints handlingGood
responsive: Flexibility and responsivenessGood
well-led: Quality assurance and governanceRequires improvement
well-led: Culture and staff supportGood
well-led: Leadership and continuous improvementRequires improvement
This focused inspection of Lincolnshire Quality Care rated both Safe and Well-led as Good, with the overall rating remaining Good. Minor recommendations were made regarding the implementation of PRN medicine protocols and updating risk assessments on the new electronic care planning system.
Concerns (3)
minorMedication management: “there were no guidance in place to support staff with administration of 'as and when required' medicines.”
minorCare planning: “Some documents required updating so this was fully captured in care planning. The registered manager assured us this action would be taken.”
minorRecord keeping: “There were some shortfalls within care records to identify people's assessed needs.”
Strengths
· People received care and support at a time and duration that met their needs, with sufficient skilled staff.
· Safe recruitment processes including DBS checks and references were in place.
· Staff had good safeguarding knowledge and had completed safeguarding training.
· Regular and detailed medicine auditing provided staff with clear feedback and lessons were learnt from errors.
· Quality assurance checks were undertaken regularly, identifying issues quickly and cascading actions to the team.
Lincolnshire Quality Care improved from Requires Improvement to Good across all five key questions following sustained improvements in staff development, governance and quality monitoring since the March 2017 inspection. Minor recruitment record shortfalls were identified and promptly addressed during the inspection.
Concerns (1)
minorRecord keeping: “records for two staff recruited in recent weeks, contained only one written reference”
Strengths
· People felt safe with staff; missed calls were a rare occurrence and staff were generally punctual
· Medicine administration records were well completed with regular audits and competency checks every four months
· Staff received regular supervision, annual appraisals, spot checks and competency assessments following improvements since last inspection
· People described staff as kind, caring and respectful, treating them with dignity and involving them in care decisions
· Care plans were person-centred, detailed and regularly reviewed; staff knew people's needs and preferences well
Lincolnshire Quality Care achieved compliance with previous regulatory breaches in medication management and governance, improving from its May 2016 inspection, but remained rated Requires Improvement overall due to inadequate staff supervision and appraisal and governance systems that were not yet robust or consistent enough to drive sustained service-wide improvement.
Concerns (5)
moderateSupervision / appraisal: “Staff did not receive effective levels of professional support... records showed a high percentage of the staff required an annual appraisal.”
moderateGovernance: “Further improvements were required to ensure the governance systems could effectively and consistently drive improvements across the service.”
moderateRecord keeping: “The quality assurance advisor told us they did not review people's care plans when assessing the log books which meant they were not able to assess if staff had delivered all of the care.”
minorComplaints handling: “Complaints received since our last inspection were not always responded to in the 28 day time frame stipulated in the policy.”
minorMedication management: “As the service supported over 200 people the sample size used was not large enough to give an accurate representation of the service's performance in this area.”
Strengths
· People received their medicines safely and as prescribed, with improved MAR recording since the previous inspection.
· Staff were recruited safely with DBS checks, references and recorded interviews.
· People were supported by small, consistent teams of regular carers who knew their preferences and needs.
· Staff treated people with dignity and respect, and people reported feeling safe in their own homes.
· A range of healthcare professionals were actively involved in people's care, with staff responsive to clinical guidance.
Quality-Statement breakdown (14)
safe: Medication managementGood
safe: Safeguarding and abuse preventionGood
safe: Staffing levels and safe recruitmentGood
safe: Accident and incident managementGood
effective: Supervision and appraisalRequires improvement
effective: Staff training and competencyGood
effective: Consent and Mental Capacity ActGood
effective: Nutrition and healthcare professional involvementGood
caring: Dignity and respectGood
caring: Person-centred and individualised careGood
responsive: Care planning and reviewGood
responsive: Complaints handlingGood
well-led: Governance and quality assuranceRequires improvement
well-led: Leadership and registered manager responsibilitiesGood