Lakeshore Care Ltd provides personal care and support to people in their own homes in Sutton. The people who use the service are mainly older people and people with a physical disability. On the day of our inspection 25 people were using the service.

At the time of the inspection, there was a registered manager. 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.

This inspection took place on 21 September 2017. The last inspection was in June 2016 and at that inspection we rated the provider overall as “requires improvement”. We found that best practice guidelines for the recording of the administration of medicines was not followed. This meant it was unclear if people had received their medicines as prescribed. We also found there was a lack of continuity for people in the staff who provided their care. At that inspection people told us they felt their needs were sometimes not fully understood as a result. At this inspection we found the provider had taken action and made appropriate improvements with these areas of service provision. We reviewed the policy and practice by staff for supporting people with their medicines. We saw medicines administration records were kept and maintained on people’s care files. Care plans for people contained clear information about any support they required with their medicines and this matched what staff told us. Staff completing medicines administration records where required to confirm whether or not people had taken their medicines and these were appropriately completed. The registered manager told us that only staff who had received training and support to do with administering medicines were allowed to support people in this way. Staff confirmed this with us when we spoke with them.

People told us they felt safe and were supported by staff who knew how to keep them safe. The provider had arrangements to help ensure that risks to people's health and safety were assessed and well managed by staff.

People told us they appreciated the consistency of staff who now supported them and said they were supported by appropriate numbers of staff. Staff recruitment procedures helped to keep people safe. Staff had the knowledge and skills to care for people effectively and felt well supported by appropriate training and effective supervision. All of this helped to maintain a stable staff team.

People told us staff knew them well and were kind and caring towards them. It was evident staff had established positive relationships with people. People also said staff valued people, treated them with respect and promoted their rights, choice and independence.

People said staff who supported them had up to date information about their needs and this was delivered in the way they wanted. We found there was consistency in the provision of care for people and this enabled caring relationships to be developed.

People and their relatives told us they were involved in the planning and reviewing of their care. There was a clear plan of care available for staff who supported people according to their needs and wishes.

People were provided with support that was responsive to their changing needs. People knew about and were able to make a complaint and were confident the provider would respond appropriately to any concerns they might have.

We received positive feedback about the management of the service. The registered manager and the staff were approachable and fully engaged with providing good quality care for people who used the service. The provider had systems in place to continually monitor the quality of the service and there were arrangements for people to be asked for their opinions via surveys. Action plans were deve

This inspection took place on the 22 June 2016 and was announced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out on 4 June 2015 when we rated the service as ‘Requires Improvement’. We also imposed three requirement notices for breaches of regulations that we checked during a focused inspection on 1 October 2015. We found the provider was meeting the regulations we looked at, but we did not amend our rating of the service as we wanted to see consistent improvements at the service.

Lakeshore Care provides personal care to people living in their own homes. They currently provide a service to approximately 19 people who live mainly in the London Borough of Sutton and pay directly for the service themselves.

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

We found the provider was not following best practice guidelines for the recording of the administration of medicines. We found shortfalls in the records which meant it was unclear if people had received their medicines as prescribed.

Furthermore we found people experienced care from a number of different care workers over a short period of time which prevented the staff from developing caring and positive relationships with people. People told us they felt their needs were sometimes not fully understood and they had to repeat the same information to a number of care workers.

Staff were able to tell us how they would keep people safe from harm. The provider had policies and procedures in place to guide them through the process and ensure appropriate action was taken. Care workers had also received training which had been refreshed regularly.

People’s health was monitored. This included making sure people had enough to eat and drink, and contacting healthcare professionals if necessary. There was a system in place for care workers to contact senior staff during out of office hours if they needed advice or support.

The service completed risk assessments which identified possible risks to people and how these could be minimised. There was a record of ‘Client Events’ which logged and recorded any significant events. The registered manager analysed the records to identify any patterns or trends, so the risk of future reoccurrences were minimised.

Care workers knew how to ensure the care they provided maintained people’s rights to privacy and dignity. This included making sure people’s confidentiality was maintained when required.

People were encouraged wherever possible to do as much as they could for themselves. This information was recorded in people’s care plans. In this way people’s independent skills were maintained. People told us care workers sought their permission before providing care, in this way care was in line with their wishes.

The provider had measures in place to ensure only suitable people were recruited into post. Once in post, training was provided in line with staffs roles and responsibilities. This training was regularly refreshed.

There were systems in place to monitor the service, and if shortcomings were identified action was taken to improve the quality of care. The registered manager was aware of their legal responsibilities to inform CQC of significant events.

People had individualised care plans which were reviewed regularly. They emphasised the person’s choice about how care was delivered. There was also information about the person’s links and contacts in the community and what they enjoyed. In this way the risks of social isolation were reduced.

People told us the office staff at Lakeshore were approachable and they felt able to raise any issues or concern

We carried out an announced comprehensive inspection of this service on 4 June 2015 and three breaches of legal requirements were found.

We found that although the service assessed people’s needs comprehensively when they first started receiving personal care with the agency; there was no evidence people’s needs were reviewed or updated over time. This meant people were at risk of receiving care that did not meet their needs.

The provider had arrangements in place to respond to people’s concerns and complaints. However, the provider did not routinely make the complaints policy available to people. Therefore the provider was not actively encouraging people to raise concerns they may have had about the service.

The provider did not notify the Care Quality Commission (CQC) of significant incidents which they are required to do under legislation. This meant we were not able to monitor if incidents were being dealt with appropriately.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook a focused inspection on the 1 October 2015 to check that they had followed their action plan and to confirm that they now met legal requirements. This inspection was announced. We told the registered manager a day before our visit that we would be coming to ensure their availability.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lakeshore Care Ltd on our website at www.cqc.org.uk

Lakeshore Care provides personal care and support to people living in their own homes. At the time of our inspection Lakeshore was providing care to approximately 33 people all of whom were self-funding their care.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During our focused inspection we found the provider had followed their action plan. We saw legal requirements had been met, although we could not improve the rating for ‘Is the service responsive’ or ‘Is the service well-led’ from requires improvement because to do so requires evidence of consistent good practice over time. The rating will be reviewed at the next full comprehensive.

This announced inspection took place on the 4 June 2015. At the time of our inspection Lakeshore was providing care to 35 people in their own homes, all of whom were self-funding their care.

At our last inspection on the 20 August 2014 we found the service was meeting the regulations we checked.

The service has a registered manager. 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 told us they felt safe using the services provided by Lakeshore Care. Staff knew the signs and symptoms of possible abuse and how to report any concerns. Accidents and incidents were recorded, and action taken to minimise the risk of a reoccurrence.

Care workers were recruited following appropriate employment checks. This ensured only suitable people were employed by the service. Care workers were provided with training so they could undertake their role within the organisation, and training was regularly refreshed.

People’s needs were initially assessed by the registered manager or senior care workers within the service to develop care plans to meet the identified needs. There were also guidelines which outlined possible risks to people and how these risks could be managed whilst maintaining people’s independence. Whilst the initial written information was comprehensive, there was no evidence it had been reviewed. This meant people could receive a service that was unsafe as it did not reflect their current and up to date needs.

People told us care workers treated them with dignity and respect. The service maintained continuity of care workers whenever possible. People were positive about this as it meant the care workers were familiar with their needs.

People told us care and support was provided with their consent and agreement.

The service sent out annual questionnaire’s to monitor the quality of the service they provided. They also undertook spot checks to ensure care workers provided safe and effective care. The service did not however encourage or solicit other comments. There was a complaints policy which was available on request only, which meant people did not have all the necessary information should they wish to complain about their care. The policy was not in a format that was accessible to people.

Care workers monitored the health and welfare of people using the service. Where issues had been found medical advice had been sought from the relevant healthcare professionals. People were supported to eat and drink sufficiently to meet their health needs.

The service had a registered manager and people told us they were approachable. The registered manager was not aware of certain responsibilities they had to notify the CQC of certain events that involved people who use the service. That meant the CQC could not monitor whether these incidents were dealt with appropriately and resolved.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.