Live Life Care Limited

The service was last inspected in October 2016, when it was rated as Requires Improvement. This was due to concerns about the safety of the service due to an inconsistent system for ensuring that all commissioned calls had taken place. At this inspection we found the provider had addressed the issue by implementing a new call tracking system which automatically made an alert if a scheduled call was not registered as having taken place within a set time scale. The provider told us, “The new tracking system has been great. It has safeguarded everything we do and is a safety net against missed and late calls. It’s our safety alert that everyone has had their visit.”

Live Life Care is a domiciliary care agency that provides care and support to adults, of all ages, in their own homes. The service provides help to people with physical disabilities and dementia care needs in central and west Cornwall. The service mainly provides personal care for people in short visits at key times of the day to help people safely maintain their independence to live in their homes.

At the time of our inspection 115 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding. The service employed 67 staff including management.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s feedback about their experience of the service was positive. People said staff treated them respectfully and asked them how they wanted their care and support to be provided. People told us they had their care visits as planned. Staff arrived on time and stayed for the allotted time. Nobody reported any missed visits.

People confirmed there was a stable staff team and that care was provided by familiar faces. Staff told us that travel times were sufficient, so they were not rushed. People’s comments included, "I get to see the same face; that makes me feel safe”; "They make sure I have something to drink and prepare my meals for the day” and, a relative commented, "They are always on time and they stay their time as well."

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals. Comments from staff included, "I have worked here for a long time; that says it all for me. I wouldn’t stay if I didn’t think they were a good employer and providing a good service to people we support.”

People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. Care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. People told us they were involved in decisions about their care and were aware of their care plans.

Daily care records were kept; these were predominantly task focused and did not provide adequate detail of the person-centred care and support provided to people. We have made a recommendation about this in the report.

The service worked successfully with healthcare services to ensure people's health care needs were met and had supported people to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. One healthcare professional told us, “I have always found the service good to work with from the point of view of keeping us aware of any issues with clients. No-one I have assessed has complained about the service.”

Staff were recruited safely, which helped ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. All staff received an appraisal of their work. Staff comments included, "I think the training is very good. We are always doing refresher training and there are opportunities to do further training in areas like dementia care.”

Accidents and incidents were accurately recorded and reported and any lessons learned were shared with staff. The service learned from any mistakes and used these as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

People’s rights were protected by staff who under stood the Mental Capacity Act and how this applied to their role. Nobody we spoke with said they felt they had been subject to any discriminatory practice for example on the grounds of their gender, race, sexuality, disability or age.

The service had a contingency plan in place to manage emergencies. Risks to people, in the event of an emergency, had been assessed and rated, in order to identify who would be at the highest risk. There was an out of hours telephone contact service available to people so they could contact staff in an emergency. This demonstrated the provider had prioritised people's care provision during such an event. People were protected as robust processes were in place to manage emergencies.

There was a positive culture within the staff team and staff spoke positively about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The provider and registered manager were clearly committed to providing a quality service to people and aimed to provide leadership by example. For example, the provider herself would undertake caring shifts in the community when needed and told us, “Our vision for Live Life Care is to provide high quality care for people in their local community; as much as possible to ensure people feel part of their community, aren’t lonely and feel valued.”

The provider was keen to provide additional community based services for people experiencing a degree of memory problems. Under the banner of Live Life Care, the provider had established different community groups as a service to people living with dementia. These included social groups to support people to make and keep social connections within their local community.

There were quality assurance systems in place to make sure that areas for improvement were identified and addressed. The service sought the views and experiences of people, their families and the staff in order to continually improve the service. People who used the service and their families told us they felt the service was well led and they felt actively involved in arrangements for their support package.

Live Life Care Ltd is a domiciliary care agency that provides care and support to adults, of all ages, in their own homes. The service provides help to people with physical disabilities and dementia care needs in Camborne, Redruth and Truro and surrounding areas. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection 131 people were receiving a personal care service. The services were funded either privately or through Cornwall Council or NHS funding. The service employed 53 staff including management.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We had some concerns about the safety of the service. This was because there had been 16 missed calls over the previous six months. People who used the service and families told us they had experienced missed calls and the timing of calls was variable and inconsistent.

People told us they did not always receive care from the same care worker or team of care workers. Some people had spoken with the service management about this issue and wherever possible the service had attempted to rectify this. However, we found continued issues with how the staffing rotas were operating. This had resulted in a number of missed visits, significant time variations between pre-arranged calls and calls where two staff members were required and one staff member undertook the call alone. People who used the service told us, “The main difficulty with the service is the uncertainty about the time of the carer’s arrival. It is difficult to plan your day when the carer can arrive anytime between 8:15am and 10:15am for a nominal 9 am appointment” and “We never know which carer is scheduled to come. I appreciate we can’t expect a seven day service from the same person, but it would be good if we had fewer carers” and “The same faults occur regularly. Arriving later than agreed time schedule, as it means I am then late for agreed appointments” and “At one time I had the same care workers regularly but for many months there has always been someone new.”

People who used the service commented favourably about the quality of care provided by staff saying, “The carers they supply are kind and considerate” and “I am very happy with my care. Any concerns raised by my family were dealt with effectively”

The service had a contingency plan in place to manage any emergencies. Risks to people, in the event of an emergency, had been assessed and rated, in order to identify who would be at the highest risk. There was 24 hour telephone contact available to people to be able to contact staff in an emergency. This demonstrated the provider had prioritised people's care provision during such an event. People were protected as robust processes were in place to manage emergencies.

Staff were recruited safely, which helped ensure they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff received appropriate training and supervision. New staff received an induction, which incorporated the care certificate. All staff received an appraisal of their work. Staff comments included, “I think the training is good. It is always being updated and important issues such as how to safely move people and the importance of infection control are always highlighted.”

Staff were knowledgeable about the people they cared for and responded appropriately as people's needs changed. Staff spoke positively about the people they supported and were motivated to provide an individualised service in line with people's needs and goals. Comments from staff included, "I really enjoy working for Live Life Care.”

People told us they were involved in decisions about their care and were aware of their care plans. Care plans provided staff with direction and guidance about how to meet people's individual needs and goals. These were reviewed regularly and updated when people’s needs changed.

The service worked successfully with healthcare services to ensure people's health care needs were met and had supported people to access services from a variety of healthcare professionals including GPs, occupational therapists and district nurses to provide additional support when required. Care records demonstrated staff shared information effectively with professionals and involved them appropriately. One healthcare professional told us, "They are good at seeking advice when needed and keeping us informed of changes in people’s needs.”

Management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a relatively positive culture in the service, the management team provided leadership and led by example. For example, the provider herself would undertake caring shifts in the community when needed. Staff described the service as ‘a good company to work for’. Other staff commented that issues with the current rota system had proved frustrating and were aware that the provider and management had a plan to improve the situation. Comments included, “It is a culture which is well meant but circumstances sometimes affect the smooth running of the work in the community, such as how rotas have been operating.”

There were quality assurance systems in place to make sure that areas for improvement were identified and addressed. The system had recognised there were issues with the current call monitoring system and rota management. This had led to the recruitment of an additional supervisory member of staff and the implementation of an electronic call monitoring system. This was being implemented at the time of the inspection.

Most people and their families told us the management teams were approachable and they were included in decisions about the running of the service. Some people felt the communication and responsiveness of the management could be better at handling situations. People had details of how to raise a complaint if they needed to and we saw that this happened. Comments from people included, "I have no real concerns about the service. I recognise the faults but no situation is perfect and I am very happy with my carers” and “I don’t have any complaints. The carers collect my weekly state pension and some grocery items each week for me.” A relative commented, “Live Life Care are very good to my mother. One carer will sit and chat with her, which is very kind and probably very important for some clients. The administration has made a few mistakes but they have been quickly rectified.”

We reviewed 27 questionnaires that the agency had recently received from people who used the service or their representative in respect of how they saw the service they received from Live Life care. The comments received in the questionnaires were all positive. Comments included; 'I am very pleased with the care', 'keep up the good work', 'brilliant', 'complete satisfaction' and 'carers are all friendly, helpful, couldn't wish for better'. The registered manager confirmed they had not received any concerns or complaints since our last visit. At the time of our inspection, there was a tendering process taking place with the local council. We were told this had caused anxiety for some people who used the service. As we had received positive comments from people who used the service on our last inspection and viewed the recent positive questionnaires , we did not contact people who used the service directly on this visit.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Care plans recorded peoples' preferences and choices regarding their personal care and support needs. However old information in people's care plans was not always removed which could cause confusion. Risk assessments did not always guide staff on how to manage identified risks.

There were not adequate systems in place to enable staff to fully protect people from the risk of abuse.

Live Life Care operated a consistently effective recruitment procedure in order to ensure that the people they employed were of good character, suitably qualified, skilled and experienced.

Staff were not appropriately supported to enable them to deliver care and treatment to people who used the service safely and to an appropriate standard.

The care plans we looked at directed and informed staff as to how the care was to be provided. They included 'offering [the person] a choice of clothes' and 'greeting [the person] with their preferred name'

The recruitment process was robust and training was provided frequently.

A newsletter was produced by the service and posted to the peoples homes. We were shown a copy which contained information about the service, advice for individuals concerning benefits and details regarding a dental service. There was a competition included and we saw three entries from people who received care from the service.