This inspection took place on 5 July 2018 and was announced. We gave the registered manager 48 hours to make sure someone was available in the office to meet with us.

At our last announced comprehensive inspection of this service on 8 January 2018 we identified issues relating to safe care and treatment, consent, person-centred treatment and good governance. We served the provider warning notices in relation to safe care and treatment and good governance which required the provider to be compliant by 5 April 2018. We rated the service ‘requires improvement’ overall. We carried out this inspection to check the provider was compliant in relation to the warning notices as well as with all other fundamental standards.

The service is a domiciliary care agency. It provides personal care to people living in their own homes, flats and specialist housing. It provides a service to older adults and younger disabled adults. There were 101 people receiving personal care from LIM Independent Living and Community Care Service at the time of our inspection.

The service had a registered manager in post. The registered manager had been in post since the service registered with us in 2012 and was also the director. 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 and associated Regulations about how the service is run.

The provider had not always submitted statutory notifications of significant events to CQC as required by law. This meant the provider did not always support us to monitor the service and plan inspections.

The provider did not always inform people and relatives if staff were going to be late and people were unhappy with this.

The provider had improved in relation to the concerns we found at our previous inspection.

People’s medicines were managed safely and the processes to assess and manage risks relating to people’s care were more comprehensive.

Care plans contained more information about people’s needs and preferences with clearer guidance for staff to follow in caring for people.

The provider had systems to assess the mental capacity of people in line with the MCA and make decisions in their best interests.

Most people told us they received care in a timely manner and the provider used an electronic system to monitor timekeeping. The way the provider used the electronic system to monitor timekeeping had improved since our last inspection.

The provider improved the way they responded to and used concerns and complaints to improve the service.

The provider had systems to assess, monitor and improve the service. Records relating to people, staff and the overall management of the service had also improved.

There were enough staff deployed to meet people’s needs and staff were recruited using suitable recruitment checks. People received care from staff who were suitable for them.

People felt safe with the staff who supported them and staff understood how to respond if they suspected anyone was being abused to keep them safe.

People received food of their choice and received any support required in relation to eat and drink. People also received support with their day to day health needs.

People liked the staff who supported them and staff treated people with dignity and respect. Staff were allocated sufficient time to care for people.

This inspection took place on 8 January 2018 and was announced. We gave the registered manager 48 hours to make sure someone was available in the office to meet with us.

At our last announced comprehensive inspection of this service on 27 November 2015 we rated the service ‘good’ in all five of the key questions we ask of services. At this inspection we found the service had deteriorated and rated them ‘requires improvement’.

LIM Independent Living and Community Care Service is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people. There were 22 people receiving services from LIM Independent Living and Community Care Service at the time of our inspection.

The service had a registered manager in post. The registered manager had been in post since the service registered with us in 2012 and was also the director. 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 and associated Regulations about how the service is run.

The provider did not assess risks relating to people’s care through a suitable risk assessment process. This meant the provider could not be assured they were managing people’s risks well. The provider had not assessed risks relating to people’s care including those relating to medicines management and those relating to people’s medical and health needs.

In addition the provider did not have care plans in place to inform staff about some people’s individual needs and the best ways to care for people in relation to these. The provider gathered information about people, including their needs and preferences before they began providing care. However, the provider did not use this information to inform care plans to guide staff on the best ways to care for people. Care plans consisted only of sheets where the tasks people required were ticked. The provider did not put care plans in place to provide staff with information and guidance about people’s physical, mental, emotional and social needs. This lack of information impacted on the ability of staff to provide person-centred care.

The provider had not carried out MCA assessments to determine whether people lacked capacity when they had reason to suspect this. The provider had also not followed the MCA in making decisions in people’s best interests as they had not determined if any people lacked capacity in the first instance.

People were not supported to receive timely care and support through technology in place. The provider invested in an electronic system to track the times people received care. However, we identified staff were misusing the system so it was not possible for the provider to track the times reliably. Although people and relatives told us they had never received a missed visit, three relatives said timekeeping was an on-going issue. The provider had not ensured staff used the electronic system reliably to help them understand and improve issues relating to lateness.

People’s care was not always scheduled well as the provider scheduled several people to receive care at the same time by each staff member. This meant people experienced lateness and staff experienced unnecessary pressure.

The provider did not also use concerns raised by people to improve the service, particularly in relation to concerns raised regarding lateness. In addition, the provider did not always respond to complaints promptly. We have made a recommendation about the management of complaints.

The provider had poor governance processes to assess, monitor and improve the service. This meant the provider had not identified the issues we found during our inspection. In addition the provider did not ensure robust recording processes in relation to people using the s

This was an announced inspection that took place on 27 November 2015.

LIM Independent Living and Community Care Services Limited is a small domiciliary care provider who provides support and care to people living in their own homes. The agency is situated in the Thornton Heath area of south London. Some of the services offered include personal care support, household tasks, companionship; rehabilitation and 24 hour live in care. There were 20 people using the service and 21 staff.

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 and associated Regulations about how the service is run.

At the last inspection in November 2013 the agency met the regulations. At this inspection the regulations were met.

People said the service provided was what they required and met their expectations. The designated tasks were carried out to their satisfaction, they felt safe and the staff team and organisation really cared. They thought the service provided was safe, effective, caring, responsive and well led.

The service kept up to date records that covered all aspects of the care and support provided for people, the choices they had made and identified and met their needs. The information was clearly recorded, fully completed, and regularly reviewed. This enabled staff to perform their duties well.

Staff where knowledgeable about the people they supported, the way they liked to be supported and worked well as a team. They provided care and support in a professional, friendly and skilled way that was focussed on the individual and their needs. They were well trained, knowledgeable and accessible to people using the service and their relatives. Staff thought the organisation was a good one to work for and they enjoyed their work. They had access to good training and support.

People and their relatives said they were encouraged to discuss health and other needs with staff and had agreed information passed on to GPs and other community based health professionals, if required. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People said the manager was approachable, responsive, encouraged feedback from them and consistently monitored and assessed the quality of the service provided.

At the time of our inspection there were six people using the service. To meet the needs of people who use the service there were approximately eighteen care workers working within the local communities. On the day of our inspection we met with the registered manager and spoke with several members of staff.

As part of our inspection we spoke with several people who use the service and or their family members by telephone. The feedback we received about peoples care and support was generally positive. One person told us “Overall I am very happy with the service. The carers that visit are all very kind and support my relative well". Another person told us “The carers are very good. Any concerns I have had have always been addressed and resolved”.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people’s family members fully involved. People who use the service told us that they knew who to speak with if they had a concern or complaint and they had been given information on the complaints process.

People experienced care, treatment and support that met their needs and protected their rights. We looked at care records and support plans for three people using the service. Care plans we examined were person centred and contained detailed guidance for staff on how to support people who use the service in all areas of their daily lives. There were effective recruitment and selection processes in place, and appropriate checks were undertaken before staff commenced work.

We saw some satisfaction surveys that had been completed recently by people using the service and/or their representatives and they were happy with the care being provided by the agency. People expressed their views and were involved in making decisions about their care and treatment.

People who use the service were given appropriate information and support regarding their care and support. Their care records showed that their needs had been assessed by the agency's staff and care plans drawn up accordingly. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The manager confirmed that people's needs were re-assessed when there were changes.

We were told that all staff had regular supervision which allowed them to discuss their performance and any individual training needs that they might have.