Lizor Care Concept was rated Inadequate overall following an October 2023 inspection, with repeated breaches of regulations covering risk management, medicines administration, staff recruitment, person-centred care, and good governance. The service was placed in special measures due to widespread and persistent failures that had not been addressed across five inspections since registration in May 2020.
Concerns (11)
criticalMedication management: “One person had not received their medicines, prescribed for the management of their epilepsy, for four consecutive days. This significantly increased the risk of them having a seizure.”
critical
Medication management
: “Documentation did not ensure the safe administration of people's medicines. One care record stated staff could administer a medicine to control a person's seizure, but this was incorrect.”
criticalRecord keeping: “Skin integrity risk assessments had not always been completed correctly. One assessment identified a person was fully mobile and incontinent of urine, but they used a wheelchair and were doubly incontinent.”
criticalSafeguarding: “Risks were not always identified, assessed, or mitigated, which did not promote people's safety. The risk of choking, skin soreness and fire hazards when using petroleum-based emollients had not been identified.”
criticalGovernance: “The auditing systems had not assured the provider that safe recruitment practice was being followed. Daily and monthly checks of medicine administration systems were undertaken, but not all shortfalls were being identified.”
moderateCare planning: “Care planning focused on tasks and outcomes and was not always person centred. Health conditions were stated in people's care plans, but the information was generic and not specifically related to the individual.”
moderateSupervision / appraisal: “Records showed one member of staff required more supervision, but there were no records to demonstrate this. There was no assessment of the staff member's competence to show they were able to carry out their role effectively.”
moderateComplaints handling: “The provider was not able to provide evidence of the complaints raised, their investigation or outcome. This did not demonstrate all complaints were addressed or that lessons had been learnt.”
moderateStaff competency: “3 job applications did not always demonstrate a full employment history, as gaps in employment had not been identified or verified. This meant safe recruitment decisions had not been made.”
moderateIncident learning: “Audits had identified there were occasions when staff were late arriving to support people, but further analysis had not been completed. Themes or trends had not been identified or addressed.”
moderatePerson-centred care: “One care plan showed the person had dementia, but not how it impacted on them or their support. This did not ensure staff were fully informed to provide support in the best possible way.”
Strengths
· Safeguarding training had been improved since last inspection; staff knew how to identify and report abuse and people felt safe with staff supporting them.
· An electronic monitoring system alerted the provider to missed or late visits, enabling timely action; people reported staff generally arrived on time.
· Good infection control practice in place; staff wore appropriate PPE and completed infection prevention and control training.
· Sufficient staffing levels maintained through the government's staff sponsorship scheme, with enough staff to cover all care packages.
· Staff divided into geographic teams with team leaders appointed to improve oversight and supervision.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
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 careInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Lizor Care Concept is a domiciliary care agency providing the regulated activity of personal care to people living in their own homes. At the time of our assessment the service was supporting 47 people. Assessment activity started on 21 May 2024 and finished on 7 June 2024. We visited the office on 30 May 2024. At our last inspection on 16 October 2023, we found significant shortfalls and breaches of regulations. We rated the service Inadequate overall and placed it in special measures. Since that inspection we have met with the provider to discuss their action plan and steps taken to make the required improvement. During this assessment the provider demonstrated that improvements had been made and they were no longer any breaches of regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in special measures. Since the last inspection a new manager had started in post and was in the process of registering with Care Quality Commission (CQC). People, relatives and staff told us the new manager had made many improvements. People’s care plans and risk assessments had all been reviewed and staff had received training in record keeping. Office staff were carrying out daily checks of people’s notes to make sure care was being delivered according to people’s needs. People had their medicines as prescribed, and staff were supporting people to manage their medicines safely. Staff had been recruited safely and received training on a range of topics. Staff had also been given regular supervision to discuss their wellbeing, any issues or concerns and training needs. Staff told us they felt supported by the management team and able to raise concerns. Staff logged in and out of an electronic system when visiting people, so the office were able to monitor visits in a timely way.
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Lizor Care Concept, a domiciliary care agency serving 20 people, was rated Requires Improvement overall following a focused inspection of Safe and Well-Led domains, with breaches of Regulations 17 and 19 identified relating to unsafe medicines management, inadequate governance and audit systems, and insufficiently robust recruitment processes. Positive findings included effective risk assessments, competent use of moving and handling equipment, and a reliable on-call support system, though these were insufficient to offset repeated and continued regulatory non-compliance.
Concerns (9)
criticalMedication management: “one instruction was 'two in the morning', but the dosage of the medicine was one tablet. This increased the risk of a medicine's error.”
criticalMedication management: “some time specific medicines had been given too close together, which increased the risk of the person being overdosed.”
criticalGovernance: “Systems had not been established to assess, monitor and improve the quality and safety of the service. This placed people at increased risk of harm.”
criticalSafeguarding: “an incident recently occurred which placed a person at significant risk of harm.”
criticalStaff competency: “Records did not show recruitment processes were sufficiently robust to ensure staff recruited had the qualifications, competence, skills and experience.”
moderateRecord keeping: “topical creams had not been identified on the MAR. Some records showed staff where the topical creams were to be applied...but this was not the case for all records.”
moderateCare planning: “people's health conditions and generic symptoms were stated, but guidance about the impact on the person was limited.”
moderateIncident learning: “an analysis of such concerns had not been considered. This did not give an overall picture of the frequency or circumstances of these situations.”
minorCommunication with families: “one relative told us they made a complaint about the staff not being able to communicate with their family member in English.”
Strengths
· Focus had been given to risk assessment and management, with up-to-date assessments covering moving, oxygen, nutrition, dehydration and skin integrity.
· Staff had received training and demonstrated competence in using mobility equipment such as hoists, praised by relatives.
· People and relatives reported feeling safe and said positive relationships had been established with staff.
· An on-call system operated outside office hours and was described as effective by staff and relatives.
· Spot checks of staff performance were regularly undertaken by the provider and registered manager.
Quality-Statement breakdown (8)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, 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 empowering; Duty of candourRequires improvement
Targeted inspection to check compliance with a Warning Notice under Regulation 17 (Good governance); enough improvement had been made and the provider was no longer in breach. The service was inspected but not rated, and the previous overall rating of requires improvement remains unchanged.
Concerns (3)
moderateMedication management: “the provider had failed to keep an accurate record of the medicines they had supported people to take”
moderateGovernance: “failed to... have effective systems to assess, monitor and improve the quality of the service provided. This was a breach of regulation 17”
moderateRecord keeping: “Changes had been made to the way staff worked, to ensure they were able to maintain accurate records.”
Strengths
· Medicines administration records had been fully completed and gave details of the medicines people had been supported to take.
· Manager developed detailed action plans with clear responsibilities, regularly reviewed to ensure they were on track.
· Provider worked with electronic records system supplier and provided additional staff training to resolve recording issues.
· A series of audits (medicines, care planning, risk assessments, staff practice observations) had been developed and acted upon.
· Quality assurance forms had been sent out to everyone who used the service to inform improvement planning.
Quality-Statement breakdown (1)
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
Lizor Care Concept remained in breach of regulations relating to safe care, accurate medicines records, governance and CQC notifications, with continued risk-management and record-keeping shortfalls placing people at risk of harm. People and relatives were positive about staff who were kind, well-trained and person-centred, and improvements were noted in infection control, safeguarding, consent and responsiveness.
Concerns (8)
criticalCare planning: “Risk management plans for one person did not include information about significant tissue and bone damage they had experienced.”
criticalCare planning: “Another person had a risk assessment which stated they were at high risk of pressure ulcers. The risk management plans did not detail how to mitigate the high risk.”
criticalMedication management: “The provider failed to maintain an accurate record of the medicines staff had supported people to take.”
criticalRecord keeping: “One person had no record of being supported with their medicine on 26 occasions. Another person had no record of support on 15 occasions and a third person had no record of support on 12 occasions.”
criticalGovernance: “The systems for monitoring the service and identifying required improvements were not effective.”
criticalIncident learning: “The provider had failed to notify CQC of significant events in the service. This was a breach of regulation 18.”
criticalSafeguarding: “We identified three incidents which had not been notified to us. The incidents included one where a person had sustained a serious injury, one where a family member made an allegation of abuse and one where there was an allegation staff had neglected a person.”
moderateLeadership: “The service did not have a registered manager. The manager was a director of the provider and had applied to register with CQC.”
Strengths
· Improved infection prevention and control measures with daily COVID-19 testing in line with government guidance
· Effective safeguarding systems and staff training; staff confident in raising concerns
· Effective recruitment procedures including DBS checks and references
· Staff received relevant induction, training, supervision and observations to support their role
· Staff worked with external professionals (occupational therapists, community nurses, palliative care) to deliver effective care
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experience
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well-led: Engaging and involving people using the service, the public and staff; Working in partnership with others
Requires improvement
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcareGood
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: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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 empowering; duty of candourGood
well-led: Engaging and involving people, the public and staff; working in partnership with othersGood