Lotus Community Care Service retained a 'Requires Improvement' overall rating following a focused inspection in July 2023, with continued regulatory breaches in recruitment (Reg 19), Mental Capacity Act compliance (Reg 11), and governance including unauthorised CCTV installation (Reg 17), resulting in warning notices. Responsive improved to 'Good', reflecting genuine strengths in personalised care, activities, communication support and partnership working, but persistent governance failures across two consecutive inspections indicate systemic leadership weaknesses.
Concerns (7)
critical
Staffing levels
: “The registered manager had not obtained a reference from a worker's most recent care and support employer... could not demonstrate they had sufficiently established a reasonable account of 2 other workers' prior employment histories.”
criticalConsent / capacity: “There was not a clear assessment of the person's capacity to make that decision or an appropriate record of a best interests decision being taken in line with required guidance.”
criticalConsent / capacity: “Records of seeking the person's consent... had been signed by a relative... there was no record the relative had the legal authority to consent to these things on behalf of the person.”
criticalGovernance: “They had not followed the provider's policy or national guidance on setting up and using CCTV... not completed an assessment of the purpose, necessity and risks of using such equipment.”
criticalGovernance: “The registered manager had not effectively operated their governance systems so as to address all of the issues we found the last time we inspected or to identify and address the issues we found at this inspection.”
minorCare planning: “There was little evidence the service used person-centred approaches and tools to plan with some people with significant disabilities, and those important to them, to understand their goals and aspirations.”
minorRecord keeping: “Recording of hot water temperatures in one of the services noted temperatures over 43°C at times, indicating potential for an increased risk of injury to people.”
Strengths
· Staff supported people with their medicines safely and medicines administration records were completed correctly with regular senior staff audits.
· Sufficient staffing levels with consistent staff enabling trusting relationships; a professional observed staff interacting positively with people.
· Effective infection prevention and control measures in place including appropriate use of PPE.
· Staff received regular supervision, appraisal and a range of training including autism and learning disability awareness.
· Service supported people to live person-centred lives, with relatives noting increased independence and professionals describing significant improvements in quality of life.
Quality-Statement breakdown (20)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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
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: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
Date of assessment 29 October 2024 to 29 November 2024. Lotus community care is a supported living service providing care to people living in their home. At the time of our assessment the service was supporting 3 people. We assessed quality statements from the safe, effective and well-led key questions. Our overall rating for the service is good. There were good systems in place to ensure that the care being provided was of good quality. People told us that staff were caring and kind. People were involved in their care planning and reviews. There was enough well-trained staff on duty to meet people's needs. Medicines was administered safely. Effective systems were in place to protect people from abuse. Staff had a good understanding of people’s needs including their cultural and spiritual needs. The provider worked well with healthcare professionals and the local authority. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
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First inspection of newly registered domiciliary care agency found four breaches of regulation covering safe care, recruitment, person-centred care planning and good governance. Care was rated caring (Good) with positive feedback from families, but risk assessments, recruitment checks, training records, care plans and quality monitoring systems were inadequate.
Concerns (7)
criticalCare planning: “Risk management plans did not effectively assess and manage risks to the person and staff presented by the person's mobility and swallowing needs.”
criticalCare planning: “the person's care plan did not always reflect the care they received... This was a breach of Regulation 9”
criticalStaff competency: “the provider had not always followed safe recruitment processes to help make sure they only employed suitable staff.”
criticalGovernance: “the provider did not always operate effective systems for monitoring and improving the quality of the service.”
criticalRecord keeping: “Records of daily care from the four weeks prior to our visit documented that the person was visited by a care worker the registered manager stated was not in the country over that time.”
moderateStaff training: “the registered manager could not demonstrate that the staff member was working to complete training to become competent in their role in line with the Care Certificate.”
moderateSafeguarding: “the provider had not completed a risk assessment of the person's home environment to make sure it was safe for staff to provide the care being asked of them.”
Strengths
· People were treated with compassion, kindness, dignity and respect; relative described staff as 'Very compassionate, very caring'.
· Staff spoke the person's first language and were familiar with their culture.
· Consistent staff visited the person, allowing trusting relationships to develop.
· Families felt involved in care arrangements and listened to.
· Service worked in line with principles of the Mental Capacity Act.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk from abuseGood
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood