This inspection took place on 6, 7 and 8 February 2017. The inspection was announced. We last inspected the service in September 2015 and asked the provider to take action to make improvements to medicines management and mental capacity. An action plan was submitted by the provider and we found the action had been completed.

L S Care Limited provides nursing and personal care for people living in their own homes, some of whom have complex health needs. L S Care Limited is also registered to provide care for children under the age of 18. At the time of the inspection they were supporting 26 people living across Northumberland, Newcastle, South Tyneside, North Tyneside and Gateshead. Some people received care and support 24 hours a day whilst other people had visiting support.

There were two registered managers in post at the time of the inspection.

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 and their relatives said they felt safe receiving care from staff. They said they felt staff were caring and treated them with dignity and respect. People also thought staff were well trained and had the knowledge they needed to care for them appropriately.

Medicines were managed safely and new procedures and training had been developed since the last inspection.

Staff had attended mandatory training in areas such as safeguarding, moving and handling and medicines management. Staff also attended training relevant to any specific needs of the people they were supporting, such as the use of ventilators, suction machines and feeding tubes. Staff also attended training on specific diagnoses such as motor neurone disease.

Staff told us they felt well supported by the management team. They said they had regular supervisions and an annual appraisal. They also said they could access out of hours support and advice when needed.

Complaints, safeguarding concerns, accidents and incidents were documented, investigated and discussed in regular quality meetings.

Capacity was recorded within care records which made it very clear that people had been involved in developing their care plans and risk assessments and were able to direct their own care and support. If there was a concern that someone may lack capacity, appropriate professionals were involved and the provider completed an internal assessment of capacity. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Robust recruitment practices were in place which supported the recruitment of appropriate staff. Practice included confirming references and seeking Disclosure and Barring Service Checks which were renewed every three years.

Care records and risk assessments were detailed and personalised. People’s likes and dislikes were documented, including their preferred routines and how they wanted to be supported. The clinical and training managers visited people and reviewed their care packages on a monthly basis. The views of people, relatives and staff were all considered and everyone worked together to achieve positive outcomes with people.

Staff, people and relatives told us they thought L S Care Limited was well-led. Quarterly audits were completed to ensure care records met the required standard, were up to date and detailed.

Staff felt they were well supported and could seek the advice and guidance of the management team as and when needed.

L S care provided support to 51 people at the time of our inspection. We carried out telephone interviews with one person using the service and three care staff.

We were unable to seek the views of some of the people using the service as they had a verbal impairment. With advance agreement we contacted and spoke to the representatives of three people who used the service.

The manager supported us at the inspection visit.

One relative told us the service was “fantastic”. Another relative said staff are “really good”. Another person said L S Care are “very flexible”.

We found people's needs were assessed and care was planned in line with their needs.

Relatives told us they felt included in the care arrangements and decisions.

People who used the service were protected from the risk of abuse.

We found that there were systems in place to monitor the quality of the service, and make improvements where required.

People told us they felt the staff respected their privacy and also helped them to maintain their independence. Some of the statements from the people included, “I am grateful to L S Care and the staff. They do things with me, not for me”; “I am able to let them know how I want things done”; “The carers always asked me what I want doing. They just don’t do things for me”; “The staff respect my privacy and treat my home with respect”.

People who used the service told us they were happy with the care they received. People told us about the support they received to remain independent in their own homes. One person told us, “95% of the time everything is ok but it is only when a new carer comes in”. Another service told us, “I am very happy with my care and the staff are very supportive”.

This inspection took place on 21, 22, 28 and 29 September 2015. The inspection was announced.

We last inspected the service on 12 September 2013 and found they were meeting all legal requirements inspected against.

L S Care Limited provides nursing and personal care for people living in their own homes, some of whom have complex health needs. At the time of the inspection they were supporting 38 people living across Northumberland, North Tyneside, South Tyneside, North Tyneside and Gateshead. Some people received care and support 24 hours a day whilst other people had visiting support.

There were two registered managers in post at the time of the inspection. 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.

The coding of medicine administration was not always completed in line with the medicine administration recording. One person receiving care was deciding when they needed to take a routinely prescribed medicine which meant they were not receiving it in line with the prescriber’s instruction. For another person we found that the provider had failed to ensure they had an appropriate supply of their prescribed medicines. A registered nurse had then administered crushed tablets via a PEG tube. This method of administration had not been prescribed for the person.

For some people consent for care and treatment was given by relatives however we did not see any evidence of mental capacity assessments or formal best interest decisions. The registered manager said, “We should focus more on best interest decisions and mental capacity in the care plans.”

Care plans and risk assessments were person centred and focused on the specific needs of each individual. We found that some care plans were unclear on the frequency that certain checks needed to made, for example when people where spending time alone, and when checks on continence and skin integrity should be made. This meant staff could be completing checks at different intervals which potentially left people vulnerable. The registered manager told us that care plans were a “Work in progress”. They offered reassurances that specific information would be added about the frequency of checks.

Staff were pro-active in seeking the advice and guidance of healthcare professionals in relation to people’s complex needs, including nutrition and continence.

People told us there were enough staff to meet their needs and they were happy that they had their own core staff team who knew their needs and were appropriately trained to care for them. People and their relatives said were caring and compassionate and respected their privacy and dignity.

Staff recruitment was robust and once in post staff received relevant training which ensured they could meet the specific needs of the person they were caring for. Supervision and appraisal were held on a regular basis and staff said they felt well supported.

Staff knew how to report any concerns in relation to safeguarding and accidents and incidents. All events of this nature were investigated and discussed by the provider in quality meetings.

Quality meetings also included a review of the questionnaires sent to staff and people using the service and any improvements to quality or changes to practice. The provider did not have a system for sharing overall findings with people and the registered manager said, “We could tighten up on things.” They went on to say that the newsletter provided an opportunity for them to share findings and actions with people and staff.

People and their relatives were encouraged to be involved in the development of their care and support and people knew how to complain if their needs were not being met. We saw that records of complaints were kept, fully recorded and investigated and people were kept up to date with outcomes and changes to procedures. People also received apologies where necessary.

Audits were completed and included actions that needed to be taken which were discussed in the quality meetings.

You can see what action we told the provider to take at the back of the full version of the report.