About the service Liral Veget Training and Recruitment Limited is a domiciliary care agency. It provides personal care to people living in 12 separate supported living houses. At the time of the assessment, 23 people who used the service received personal care. CQC does not regulate premises for supported living; this assessment looked at people’s care. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
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Liral Veget Training and Recruitment Ltd was rated Requires Improvement overall following a March 2023 inspection, with five regulatory breaches identified spanning safeguarding, risk management, medicines, person-centred care, staffing and governance. The Well-Led domain was rated Inadequate due to ineffective quality assurance, failure to cooperate with the local safeguarding team, and leadership lacking awareness of key regulatory frameworks.
Concerns (11)
criticalSafeguarding — “The provider had not cooperated with the local safeguarding team and not provided the requested information. The provider had also not conducted their own investigation into the concerns raised.”
criticalMedication management — “One person's MAR stated paracetamol was to be given '4 times a day as required' with no information about the dose or frequency.”
criticalStaff training — “Staff who were supporting someone at risk of having seizures had not received Epilepsy awareness and emergency medication training.”
criticalGovernance — “Quality assurance processes were in place but they had not been effective and had not identified the issues we found with care plans, risk assessments, medicines and staff training.”
criticalLeadership — “The current and former nominated individual did not have an understanding of the responsibilities of registered providers under Right Support, Right Care, Right Culture.”
moderateCare planning — “Risk assessments and care plans contained unprofessional descriptions of people's behaviour that were not person-centred.”
moderatePerson-centred care — “There was very limited information in place about people's life history...a lack of information about how people were supported to follow interests and engage in activities.”
moderateConsent / capacity — “The provider had not conducted a capacity assessment and there was no Court of Protection authorisation in place.”
moderateIncident learning — “There was no system in place to collate and analyse incidents.”
moderateSupervision / appraisal — “There was also no record of staff appraisal in the files we reviewed... One member of staff told us, 'It's meant to be every 3 months. But this is not happening.'”
moderateRecord keeping — “One person's risk assessment stated their medications should be administered via the PEG. This was outdated information as the PEG was removed in July 2022.”
Strengths
· Staff followed safe hygiene practices and had a plentiful supply of PPE with training and ongoing support on infection control procedures.
· Safer recruitment processes were generally followed including DBS checks, right to work, employment history and references.
· New staff had a comprehensive induction and probation period including completion of the Care Certificate.
· Staff told us they adapted their communication to meet the needs of people, including use of pictures, objects of reference and sign language.
· The service had an accessible complaints policy and relatives were satisfied with how complaints were resolved.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersInadequate
well-led: Engaging and involving people using the service, the public and staffGood