What life is like for people using this service:

¿ The provider did not have adequate systems and processes to monitor the quality of the care people received.

¿ The provider did not have robust systems to assess peoples’ risks; they did not use nationally recognised or evidence based tools, or follow best practice guidance to assess risks and plan people’s care.

¿ The provider did not always demonstrate knowledge of how to mitigate people’s known risks. People were at risk of receiving care that was not appropriate or met their needs.

¿ Staff did not receive all the information and guidance they required to provide care that met people's needs.

¿ People’s care was not regularly reviewed; people were not always involved in reviewing their care or creating their care plans.

¿ Staff understood their roles and responsibilities to safeguard people from the risk of harm.

¿ People had developed positive relationships with staff. Staff had a good understanding of people's preferences.

¿ Staff did not receive all the information and guidance they required to provide care that met people's needs.

¿ People were supported to have enough to eat and drink to maintain their health and well-being.

¿ People were supported to access relevant health and social care professionals. There were systems in place to manage medicines in a safe way.

¿ Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA). Staff gained people's consent before providing personal care.

¿ People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted.

¿ People using the service and their relatives knew how to raise a concern or make a complaint. There was a complaints system in place to respond appropriately.

¿ There was a positive culture within the service where staff communicated well.

We made one recommendation relating to end of life care.

The provider was in breach of one regulation. This is the third time the provider has been rated as Requires Improvement. The action we have taken is detailed at the end of the report.

More information about our inspection findings is in the full report.

Rating at last inspection: Requires Improvement (24 November 2017)

About the service: This domiciliary care agency provides personal care to people living in their own homes. At the time of inspection three people were receiving personal care.

Why we inspected: Scheduled inspection based on previous rating

We carried out an announced full comprehensive inspection of Lighthouse Care Agency who provide care and support for adults with mental health conditions and older people who require assistance with their personal care. Not everyone using Lighthouse Care Agency received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection there were three people receiving personal care.

There was a registered manager, however, they were absent for more than 28 days. 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. One of the directors of the company was managing the service in the absence of the registered manager.

During the last comprehensive inspection 28 September 2016 we found that Lighthouse Care Agency were in breach of four of the Health and Social Care Act Regulations. We issued four warning notices. We carried out a focussed inspection 9 February 2017 and found that they were compliant with the Regulations.

During the focussed inspection in February 2017 the provider told us they intended to implement a computerised system to manage the governance of the service and update their risk assessments to reflect current legislation, standards and evidence based guidance, however, this had not been implemented. This had led to findings at this inspection of poor record keeping and a lack of oversight of staff training, rotas and out of date policies. There was a lack of audit in compliance with infection prevention policy. The provider failed to follow their recruitment policy which led to unsafe recruitment practices. We have made a recommendation to the provider to implement the proposed computerised system as a matter of priority.

People received care from staff that knew them well; they had positive relationships. People received their care at the planned times and staff were flexible to adapt to people’s changing needs. People received their meals and drinks as planned.

People’s risks were assessed and care plans were in place to mitigate the risks; these were updated regularly or as people’s needs changed.

People were receiving their medicines as prescribed; we made recommendations that the provider refer to the up to date NICE guidelines about providing medicines in people’s homes.

People’s care was provided by staff that had received training and support to carry out their roles. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them.

Where people chose to stay at home as they approached the end of their life, staff were flexible in their approach to providing for their needs. They referred people to healthcare professionals for assessment and symptom control.

People were protected from the risk of infection by staff that complied with their infection prevention policy.

People knew how to complain and systems were in place to act on any complaints. However, there were no systems in place to ensure people with a disability or sensory loss could access and understand information they were given. We made a recommendation that the provider explores how they will comply with the Accessible Information Standard.

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. The service had an open culture which ensured people were treated with respect and working practices were carried out in line with the protected characteristi

We carried out an announced comprehensive inspection of this service on 28 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Lighthouse Care Agency on our website at www.cqc.org.uk

This announced focussed inspection took place on the 9 February 2017. Lighthouse Care Agency is a domiciliary care agency that provides care and support to people living in their own home to enable them to retain their independence. When we inspected the service provided care and support to four people. The service is predominantly provided to people living in and around Northampton.

A registered manager was 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. The registered manager did not always meet these legal requirements.

The registered manager had implemented systems to assess, monitor and improve the quality and safety of people using the service, but these required further work to ensure that they became embedded into practice.

People were protected from potential harm as staff had received training and understood their responsibilities to safeguard people. The provider’s safeguarding policy had been updated and provided details on when and how to report a safeguarding concern.

People were protected from the risks associated with the management of medicines as the registered manager had implemented systems to manage people’s medicines safely.

The registered manager understood their responsibilities in notifying CQC of incidents.

This domiciliary care inspection took place 28 September 2016.

Lighthouse Care Agency is a domiciliary care agency that provides care and support to people that require this to enable them to retain their independence and continue living at home. When we inspected the service provided care and support to five people. The service is predominantly provided to people living in and around Northampton.

A registered manager was 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. The registered manager did not always meet these legal requirements.

People were not always safeguarded from potential harm as the manager and staff did not have sufficient knowledge of how to recognise suspected abuse or how to report this to the relevant authorities.

People could not be confident that they received all of their medicines as there were no records of the medicines they received. There was no managerial oversight or audit of the management of medicines.

People could not be assured that there was managerial oversight of the monitoring of the service. There was a lack of insight into the issues with safeguarding, medicines and required notifications to CQC. The provider did not have suitable systems and processes to assess and monitor the service to improve the quality of the care provided.

Staff were recruited safely, however staff had not received up to date training or formal supervision and appraisal.

People’s risks had been assessed and care plans were in place to mitigate identified risks. People were involved in the creation and review of their care plans and consent was sought before people received care.

People were supported to access relevant health and social care professionals to ensure they receive the care, support and treatment that they needed.

People sustained good relationships with the manager and staff, who respected their individuality. Staff maintained people's dignity when providing personal care and people’s privacy was respected.

There have been three breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of The Care Quality Commission Registration Regulations 2009. You can see what action we have taken at the end of the report.

During our inspection we found that records contained up to date information of the care that people had received.

We found that care was compassionate, responsive and effective.

We spoke with people and their family members and they told us that they thought the care and support provided by Lighthouse Care Ltd was excellent. One person said “They are brilliant I would not swap them, they are thorough and do things in the way I want them to be done”. Another person told us that “the staff are very kind”. We spoke with a care manager and they said that they were very pleased with the support that Lighthouse care had provided to one of their people.

We found that care was carried out in a dignified and respectful way, and that staff had the required experience and skills to enable them to carry out their role.

We saw that there had been improvements in the way that assessments of care had been completed, and that records where now kept securely. We had minor concerns about the repetitive comments in one of the daily records as this had not accurately reflected the care and any changes on a day to day basis. The provider removed this method of record keeping on the day of our inspection.

We found that the provider sought comments from people who used the service in order to make any improvements. We noted that the feedback from people about the quality of the service was very good and that there had been no complaints raised since our last inspection.

We spoke with one of the two people who used the services of Lighthouse Care Agency and they told us that “I couldn’t wish for better” and that they were very happy with the care that they received. We spoke to a relative who told us that they would give Lighthouse Care Agency “eleven out of ten” for the care they gave to their family member.

Although we were told by people and their relatives that they were very happy with the care provided. We found that the records kept and care plans written by Lighthouse Care Agency required improvements in accuracy and legibility as they were not always well written, and did not contain clear information of the care that was required.

The person who was able to give an opinion of this service was highly satisfied by the friendliness and efficiency of the staff member who provided support. A relative also said that she was satisfied with the service provided to her husband. Both people said that the registered manager and the registered owner are very approachable and friendly and will act on any issues raised.