The inspection of L H Social Care Ltd took place on 24 January 2018. We previously inspected the service on 22, 23 and 24 November 2016 and the service was rated as requires improvement in two of the five key questions and overall, and as good in three of the five key questions. On this visit, we checked to see if improvements had been made.

L H Social Care Limited is a domiciliary care and supported living service. It provides personal care for adults and children living in their own homes throughout Barnsley and the surrounding areas. People who use this service have a wide range of needs including younger and older people who are living with a learning disability, people living with dementia, as well as people with mental health needs and physical disabilities. At the time of our inspection 33 people were receiving support from this provider.

The service had a registered manager in place. 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.

There were risk assessments in place which covered the environment in which people were supported and person specific risk assessments which identified risks and the measures which were put in place to minimise the risks to people.

People who used the service and their relatives told us people were very safe with their care workers. They also said staff knew what they are doing and were kind and respectful. People were happy with the service they received from LH Social Care Limited.

People were supported with medication and told us they were confident their medication was administered and recorded properly. People with prescribed topical creams said these were applied properly and care workers took appropriate hygiene precautions. We found body maps were not always completed within care plans to show where creams needed to be applied.

Staff recruitment was robust and staffing levels were sufficient to meet people’s needs. People were supported by small teams of regular care workers.

Records showed staff had access to training and regular supervision. Staff we spoke with told us they felt supported.

People told us they were not routinely informed if care workers would be arriving later than the scheduled care visit time. The service was in the process of implementing a rota management system and we will check the effectiveness of the system at our next inspection.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff had undertaken training on the Mental Capacity Act (2005) and deprivation of Liberty Safeguards. Staff were able to explain how this legislation related to the people they supported, which meant people’s rights were being protected.

People told us their care workers are kind and compassionate.

Care workers promoted and respected people’s confidentiality, dignity and privacy. Care workers took time to build a good rapport and got to know the people they supported.

People received support with their nutrition and dietary requirements.

People and their relatives were involved in their care planning and in agreeing the support they needed.

People were supported to retain their independence. People told us they were able to make their own decisions and their preferences were taken into consideration.

The service had a complaints policy and process in place. People told us they knew what to do if they had any concerns or complaints about the service.

Feedback regarding the registered manager was positive. People spoke highly about the management of the service.

A system of audits and checks was in place to monitor the safety and quality o

This inspection took place on 22, 23 and 24 November 2016 and was announced. We told the registered manager three days before our visit that we would be coming to ensure the registered manager and staff were available for us to talk with. We also arranged to meet with people who used the service in their homes and to contact other people who used the service by telephone.

LH Social Care Limited - Barnsley is registered to provide personal care. Support is provided to adults and children living in their own homes throughout Barnsley and the surrounding areas. At the time of the inspection the service employed 38 staff and care was provided to 28 people, equating to approximately 856 care hours.

At the last inspection on 26 February and 3 March 2016 the service was rated as inadequate and was placed into special measures by CQC. On this inspection we checked to see if any improvements had been made with the breaches of regulation identified at that inspection. These included, regulation 12 safe care and treatment, regulation 17 good governance and regulation 18 staffing. When we inspected LH Social Care Limited - Barnsley we found the registered provider had made improvements in all areas.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a manager at the service who was registered with CQC. The registered manager of this service is also the registered provider. It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. 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.

There were generic and person specific risk assessments in place for most people. We found no risk assessment in place to identify the possible risks in relation to a specific risk for one person, although all relevant information relating to the risk was recorded in their care plan.

People who used the service said they felt safe whilst receiving support and care from staff. People looked forward to their visits from staff. Their comments included, “I get on with them all, they’re great people” and “I don’t know what I would do if this service was taken away. I really rely on them.”

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice. This helped to protect the rights of people who may not be able to make important decisions themselves.

There were enough staff employed to make sure visits were carried out at the agreed time. The registered manager made sure full employment checks were completed for all staff before they were offered a position at the service.

Staff had developed positive and caring relationships with the people they cared for and knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. People felt staff were caring and treated them with dignity and respect as well as supporting them to maintain their independence while providing care.

There were improvements in the way complaints were investigated and responded to since the previous inspection.

People's needs had been assessed when they started to use th

LH Social Care Limited - Barnsley provides personal care to adults and children living in their own homes throughout Barnsley and the surrounding areas.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

We announced this inspection to the registered manager two days before our visit. We did this because the manager is sometimes out of the office and we needed to be sure that they would be available.

The service has a history of breaches of regulation. The agency was last inspected on 22 and 29 June 2015 and was not meeting the requirements of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We imposed an additional condition on their registration as a service provider in respect of the regulated activity, personal care. The condition states: The registered provider must not provide the regulated activity ‘personal care’ to any further service users not already being provided with personal care without prior written agreement from the Commission until the location has a follow up inspection and we are satisfied the location is not in breach of regulations.

On this inspection we checked to see if any improvements had been made with the breaches of regulation identified at the last inspection. These included, regulation 12 safe care and treatment, regulation 17 good governance, regulation 18 staffing and regulation 19 fit and proper persons employed.

When we inspected LH Social Care Limited - Barnsley we found the registered provider had made improvements in all areas, but these were insufficient to fully meet regulations.

The systems in place to assure quality and identify improvements were not sufficiently robust, which meant people did not benefit from a constantly improving service, where they did not have to continually raise the same areas for improvement.

The registered manager promoted strong values and a person centred culture that staff understood and delivered in practice. Kindness, respect, compassion and dignity were principles on which the service was built and people told us those values were reflected in the day to day practice delivered by care staff. However, care routines and risk assessments that had been reviewed did not always support this with some risk assessments not always being followed and some records containing inaccurate information and/or gaps in information.

People were confident in reporting concerns to the manager, but didn’t always feel they were acted on properly as the same concern often arose again.

Better systems were needed to ensure sufficient numbers of staff were deployed to meet people’s needs.

We found improvements with the training and supervision of staff to maintain and update their skills and knowledge. However, gaps remained with some staff’s training and the actions from supervisions had not always been addressed in a timely way. In addition, we found staff had not received an annual appraisal.

Staff sought people’s consent to care and treatment, but their understanding of MCA and DoLS needed to improve so that people’s rights were respected.

We found the systems and processes to manage medicines in a safe way and recruit staff had improved.

People had confidence in the service and felt safe when receiving support.

People were supported to have sufficient to eat, drink, maintain a balanced diet and access healthcare appointments where this was part of their care routine.

The overall rating for this service is inadequate and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action t

LH Social Care Limited - Barnsley provides personal care to adults and children living in their own homes throughout Barnsley and the surrounding areas.

At the time of our inspection the service were supporting 48 people. As part of our inspection we spoke with three of those people and the relatives of six people. We also visited four people before our visit in their own homes. On two of the visits, care staff were in attendance and we also spoke with them. On the other two visits we spoke with both the person and their relative. We also spoke with a relative of two people who had previously received support.

At the time of the inspection the service employed 42 staff. We contacted fourteen staff and were able to speak with eight.

We told the provider three days before our visit that we would be coming. We did this because the manager is sometimes out of the office and we needed to be sure that they would be in. We then visited the offices and spoke with the registered manager and the training manager.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

On our two previous inspections on 20 November 2013 and 24 April 2014 we had asked the registered provider to improve records. This was because there was a lack of proper information and documents about people in relation to their care and treatment to protect them from risks of unsafe or inappropriate care. On 24 April 2014 the provider also needed to improve their systems and processes in relation to the management of medicines. The provider sent us action plans stating the improvements they would made to comply with those regulations. When we inspected LH Social Care Limited - Barnsley we found the provider had not made sufficient improvements.

We found the systems and processes to manage medicines had improved, but the systems and processes in place to manage risks associated with medicines had not always been followed by staff.

In the main, the manager carried out assessments of people, identified risks and attended reviews of people’s care. This was not always reflected in people’s care records, presenting a risk of people receiving unsafe or inappropriate care. Neither was it clear from people’s care records the care and support to be provided for people.

The registered provider did not have all the information required to demonstrate the safe recruitment of staff. This meant the provider had not maintained consistency in that area as we had told them about this on our inspection on 20 November 2013.

People and relatives we spoke with told us they were confident staff had the knowledge, skills and experience they needed to carry out their roles and responsibilities. Staff confirmed they were trained prior to providing care and support to people who used the service and following initial training felt supported in their job role. We found there were some gaps in that training and/or some staff had not received refresher training to maintain and update their skills and knowledge.

Although people who used the service expressed satisfaction with the service provided and staff felt supported and able to voice their opinions about the quality of care, the quality assurance system was not structured and this led to identified risks not being dealt with in a timely way.

Care staff had a good understanding of what to do if they saw or suspected abuse during their visits. They were clear that this must be reported to the manager of the service and were confident they would act on that information.

People told us they received care from staff that they knew well and that they had a team of regular care staff that visited them that was reliable. People told us their care workers were kind, caring and considerate. It was clear from our discussions with care staff that they enjoyed caring for people who used the service, because they spoke of people in a caring and thoughtful way. Care staff demonstrated familiarity and knowledge of people’s individual needs, life history, their likes and dislikes and particular routines.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

This was a scheduled inspection in addition to checking that improvements had been made to concerns raised during our inspection on 20 November 2013 and concerns that had been raised with us since the last inspection.

During our inspection on 20 November 2013 we identified concerns about the recruitment of staff and records.

At the time of this inspection, records showed there were 33 people who were supported by the service. We telephoned eleven people that used the service, or their representatives to ask them about their experiences of LH Social Care. We were able to speak with seven people.

We were also able to visit one person in their own home, where a family member and two care staff were present.

We also telephoned seven care staff employed by LH Social Care to ask them about their experiences of working for the agency. We were able to speak with three staff. We also spoke with three staff in person at the agency’s office.

In addition to speaking with people who used the service and/or their representatives, staff and the registered provider, we also reviewed a range of relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

Improvements had been made in the recruitment of staff, because in the main, we found recruitment documents were now in place before staff commenced work, which meant the registered provider/manager could be assured staff were safe to work with vulnerable people and what qualifications they had in place to ensure they were safe to do their job.

People were protected from the risk of infection because staff had equipment available to them to control the spread of infection.

Although care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare, the absence of a care plan and risk assessment in people’s homes and in some cases the absence of a care plan and risk assessment about aspects of people’s care, for example, medication, meant there was a risk to people that accurate and appropriate information about them was not in place.

Safe systems were not in place to protect people against the risks associated with the management of medicines because appropriate arrangements were not in place for the recording, handling, safekeeping and safe administration of medicines for the purpose of the regulated activity.

Some improvements had been made in some records that were required for the management of the regulated activity, for example, the training that staff received and a record of staff’s supervision. However, people’s personal records did not provide a full and detailed account of the care to be provided, which presented risks in the provision of their care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines and records.

Is the service effective?

People and their families described how they were involved in the assessment and care planning of their health and care needs, so that they received care that met their needs and supported their rights. People who used the service and/or their representatives said, “there’s a care plan and book about tasks they’ve to do. They’re a really cracking firm, they’re lovely. It’s an excellent service,” “I was part of the assessment process and the support offered is what’s been agreed for years. LH Social Care provide valuable support. They provide my relative with choice. We were introduced to staff and the staff are kind and caring. My relative’s communication is limited, but we would know if they were unhappy because of their behaviour. My relative likes routine and that’s what LH provide,” “the staff have a care plan. It’s a book they write in, with the care provided. There have been hiccups, but overall it’s ok. The staff seem to care. My relative will tell them if they’re not happy and they don’t complain”, “they were very good with the assessment process and plan of care, which fitted in with our needs. It was spot on for what we wanted. We put the care plan together” and “my experience with LH has been very good. We always have the same group of staff who are supportive and concerned. I was involved in the assessment and LH got a copy of the care plan from social services. I don’t know of a care plan from them”.

Is the service caring?

Comments received by people who used the service and/or their representatives told us that people were respected by staff who delivered care and support. People told us they were able to discuss personal matters with staff without feeling worried.

People who used the service and/or their representatives told us staff helped people with their daily activities such as personal care and social activities as required.

Is the service responsive?

People were supported in promoting their independence. People who used the service and/or their representatives told us that people were helped by staff to maintain their independence.

Care was planned and delivered in a way that was intended to enable people who used the service to live as fulfilled a life as possible.

Is the service well-led?

People who used the service, their representatives and staff were asked for their views about their care and they were acted on. When we spoke with people who used the service, their advocates and staff they all told us that in the main the service listened to their concerns and acted on them. No-one had any concerns about the management of the service or the service provided. One comment received included, “very impressed with LH and how they ‘started off’. The boss visits regularly and leaves me confident of the service with no qualms. I could tell how she spoke it would be good”.

Staff we spoke with also told us they felt supported by the management of the service and that the service was well led. Their comments included, “LH social is a fantastic company to work for. The manager is very approachable, amenable and helpful. I have no concerns or worries; they are easy to talk to”, “it’s a good company. There’s always somebody on the end of the phone. I feel well supported. Everyone gets one to one person centred care and people’s independence is promoted”, “the best thing about this company is that they are friendly and approachable” and “staff aren’t just a number at LH Social”.

If you want to see the evidence supporting our summary please read the full report.

People told us the care provided for them met their care and welfare needs and that staff always agreed the care to be provided with them and acted on that information. One person said, “Moving to LH is best thing I ever did. I’m visited every month to see if everything’s ok or I’ve anything to discuss. The carers are lovely. I can’t speak highly enough of them. They’re professional and always willing to go the extra mile without overstepping professional boundaries. When the service started I had an assessment carried out and staff didn’t start until they’d received training.”

Recruitment documents were not always in place before staff commenced work, which meant the provider/manager could not be assured staff were properly qualified and able to do their job.

There was enough staff to meet people’s needs. Staff confirmed they had set rotas that were agreed with them. People using the service confirmed they had consistency with their team of staff and any changes were discussed with them and they agreed to the staff member then providing care. Everyone using the service had confidence in their team of care staff and felt that they had appropriate skills and experience to care for them.

Records did not support that staff had received all the relevant training appropriate to the work they were to perform and that supervision was taking place.

People’s records did not always contain appropriate information and documents in relation to the care provided.

We spoke with six people who used the service or were representatives of people who used the service. Most of them told us they were very satisfied with the care and support received. Their comments included:

“Always know who is coming, can rely on that.”

“More than happy with the service, they are brilliant.”

“Same consistent group of staff; makes all the difference, we get to know them well and most importantly they know us.”

We saw records that showed people who used the service and their representatives were involved in developing their own plans of care. People we spoke with said they understood their care and support plans and that staff had explained things well to them.

People who used the service and their representatives said staff were knowledgeable regarding their support needs. They said they were treated well. Their comments included:

“They know what they are on with.”

“They seem very well trained, can’t fault them.”

Representatives of people who used the service and people who used the service had no concerns over the safety of themselves or their relatives. They said they felt they were “In good hands”.

We spoke with five staff and the manager of the service. They all said people received good care and their needs were appropriately met. They told us people’s rights and choices were respected and good systems were in place to make sure people’s privacy, dignity, and independence were promoted.

LH Social Care Limited - Barnsley provides personal care to adults and children living in their own homes throughout Barnsley and the surrounding areas.

We told the provider four days before our visit that we would be coming. We did this because the manager is sometimes out of the office and we needed to be sure that they would be in. We then visited the offices and spoke with the registered manager, quality assurance manager and a staff member whose role was the functioning of the office.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

On our three previous inspections on 20 November 2013, 24 April and 18 December 2014 we had asked the registered provider to improve records. This was because there was a lack of proper information and documents about people in relation to their care and treatment to protect them from risks of unsafe or inappropriate care. After the inspection on 18 December 2014 the registered provider and registered manager were issued warning notices stating the timescale for those improvements to be made.

On 24 April and 18 December 2014 the registered provider and manager was told they needed to improve their systems and processes in relation to the management of medicines. After the inspection on 18 December 2014 the registered provider and registered manager was issued warning notices stating the timescale for those improvements to be made.

Also, at the inspection on 18 December 2014 the provider was asked to make improvements with their systems and processes for recruiting, inducting, training, supervision and appraisal of staff and the governance of their systems and processes. The provider sent us action plans stating the improvements they would made to comply with those regulations.

When we inspected LH Social Care Limited - Barnsley we found the registered provider had not made sufficient improvements.

We found the systems and processes to manage medicines had improved, but gaps in the recording the receipt of all medicines meant that records were inaccurate and errors would be difficult to identify.

Records had been improved and we found a care routine in place for people who used the service, with risk assessments in people’s homes. However, we continued to find records that were inaccurate and incomplete due to them not being reviewed after the care provided had been changed or the action to be taken by staff had changed because of the risks presented.

The registered provider continued not have all the information required to demonstrate the safe recruitment of staff.

We found there had been improvements with the induction and training of staff to maintain and update their skills and knowledge, but improvements were still needed with the level of supervision of staff and appraisal.

The majority of people who used the service and their relatives expressed satisfaction with the service provided. Most people and relatives we spoke with said there was considerable improvements in the service and the agency itself. One relative said, “Six months ago it was dreadful. The office was ineffective and things have changed.” Two relatives said improvements were still required.

When we spoke with staff they felt supported and able to voice their opinions about the quality of care, but staff felt some improvements that were needed were not listened to by the registered manager.

Improvements had been made with quality assurance processes, but the system did not operate effectively to assess and monitor the service against the requirements of the regulations.

We found the registered manager had investigated a safeguarding concern that had been reported to them by an external source, but they had not reported this to the Commission.

The system for receiving and acting on complaints was not sufficiently robust. We found complaints that were not recorded on the complaints system, complaints where there was no clear audit trail of what the complaint was, the investigation of the complaint, the response to the person making the complaint and the action to be taken to learn from the complaint, to minimise the risk of the same complaint being made again.

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